PART I. VISION AND MISSION University of the East Ramon ... 2016 Body.pdf · Memorial Medical...

UERM OPHTHALMOLOGY: Resident Training Manual

PART I. VISION AND MISSION

University of the East Ramon Magsaysay

Memorial Medical Center

DEPARTMENT OF OPHTHALMOLOGY

V I S I O N

WE, THE MEMBERS OF THE UERMMMC DEPARTMENT OF OPHTHALMOLOGY,

DEDICATE OURSELVES TO BE COMPASSIONATE AND PROFESSIONAL EYE CARE PROVIDERS

WHO DELIVER COMPREHENSIVE AND EXEMPLARY SERVICE TO OUR FELLOWMEN.

C O R E V A L U E S

Unparalleled care

Sincere commitment for others

Excellence

Driven to do better at all times

Respect

Do what is right

Motivation

Consistent initiative to improve

M I S S I O N

PROVIDE OPHTHALMOLOGIC SERVICE IN ACCORDANCE WITH UNIVERSSALLY

ACCEPTED STANDARDS OF CARE. IMPLEMENT A DYNAMIC AND COMEPTENCY-BASED

TRAINING PROGRAM. PURSUE RELEVANT EYE RESEARCH RESPONSIVE TO THE EVOLVING

SCIENCE OF OPHTHALMOLOGY. CULTIVATE A CULTURE OF DISCIPLINE, PROACTIVE AND

SOCIALLY RESPONSIBLE LEADERS.


2

PART II. DEPARTMENT ORGANIZATIONAL CHART


PART III. FACULTY AND SUBSPECIALTIES

CONSULTANTS STATUS ACADEMIC

RANK

SUBSPECIALTY

Rizalino Felarca, MD Active Professor 3 Gen. Ophthalmology

Efren Garcia, MD Active Associate Professor

4

Gen. Ophthalmology

Jesus Tamesis Jr., MD Active Associate Professor

4

Neuro-Ophthalmology

Benalexander Pedro, MD Active Associate Professor

3

Uveitis / Medical Retina

Roumel Litao, MD Active Assistant Professor 5 Medical Retina

Jose Luis De Grano, MD Active Assistant Professor 4 Surgical Retina

Edgar Leuenberger, MD Active Assistant Professor 4 Glaucoma

Rigo Daniel Reyes, MD Active Assistant Professor 4 Glaucoma

Mark Anthony Imperial,

MD

Active Assistant Professor 3 Orbit / Oculoplastics /

Lacrimal

Fay Charmaine Cruz, MD Active Assistant Professor 2 Pediatric Ophthalmology

/ Strabismus

Ronnie Pimentel, MD Active Assistant Professor 1 Cornea / Refractive

Surgery

Maria Cecilia Garcia-

Arenal, MD

Active Assistant Professor 1 Surgical Retina

Ian Bejamin T. Hizon MD Active Assistant Professor 1 Gen. Ophthalmology

Irene R. Felarca, MD Active N.A. Glaucoma

Eric Constantine Valera,

MD

Active N.A. Orbital Pathology

Glenn Guevera, MD Active N.A. Neuro-ophthalmology

Tommee Lynne

Tayengco-Tiu, MD

Active N.A. Cornea / External Disease

Francisco Miguel

Fernandez, MD

Visiting N.A. Gen. Ophthalmology

Jonathan Rivera, MD Visiting N.A. Glaucoma

Cynthia Versosa-Canta,

MD

Visiting N.A. Glaucoma

Ralph Velenzuela Visiting N.A. Orbital Pathology

Jocelyn Therese M.

Remo, MD

Visiting N.A. Refractive Surgery

Anna Theresa G.

Fernando, MD

Visiting N.A. Gen. Ophthalmology


4


PART IV. THE RESIDENCY PROGRAM

A. General Objectives

1. To produce ophthalmologists with a well-rounded clinical and surgical

competence. He/she shall be qualified to practice ophthalmology in the

local setting and be capable of ophthalmology practice adhering to

international standards.

2. To train ophthalmologists to possess the capability to undertake research

and teaching.

3. To inculcate among ophthalmologists the duty and the need to aspire for

continuing professional growth and development.

4. To make ophthalmologists aware of their ethical and social responsibilities

B. Selection of Incoming Resident Physician

The source for Resident Eligibility and Selection will be the UERMMMCI

House Staff Policies Rules and Regulation 2013-2014. In addition, the applicants

for residency must have:

1. Qualification:

a. Must be a graduate of a duly recognized medical school

b. Must have completed one year of internship in an accredited

hospital

c. Must have passed the Philippine Medical Board Examination

d. Must have attended the Basic Course in Ophthalmology given

by UP-PGH

e. Must have passed the departmental screening for admission to

the program

2. Requirements:

Applicants will be required to submit and complete the

requirements given by the Department of Ophthalmology

3. Evaluation:

a. Written Exam/Interview Process

Each applicant will be subjected to written examination in

ophthalmology and interview to be conducted by the training committee.

Recommendations will be given by a majority vote (based on the Resident

applicant’s evaluation form) and duly approved by the chairperson.

Criteria for Evaluation (rating 0-10):

Adaptability

Communication

Initiative

Interpersonal Skills


6

Judgment

Problem Solving

Professional ethics

Leadership

Resilience

b. Pre-Residency

The applicant would undergo one months of pre-residency and will

be assessed based on evaluation of performance.

c. Case Presentation

The applicant is required to present a case presentation before the

end of pre-residency period. They will be graded on a basis of 0-100%

and must achieve a score of no less than 75% to receive a “Satisfactory”

grade for the presentation.

Criteria for Case Presentation:

1.1.1 Content (50%)

1.1.2 Delivery (15%)

1.1.3 Visual Aids (10%)

1.1.4 Preparedness (10%)

1.1.5 Knowledge of subject matter (15%)

d. Grading System

4. Resident Applicant’s Evaluation Form

5. Case Presentation Grading Sheet

Appointment / Acceptance Process

Successful applicants will be receiving a letter of appointment from

the department, which will be forwarded to the hospital training office for

distribution. Residency training of successful applicants will start on

January 1 of each year after one-month pre-residency orientation.

Rejection Process

The unsuccessful applicants will be notified through e-mail and SMS.

C. The Resident Duties

1. Hours

Residents are expected to attend teaching sessions generally scheduled for

08:00H. The opthalmology outpatient clinic regularly starts at 09:00H and

usually end around 15:00H. Admissions and emergency consults are

generally seen after regular clinic hours.


Residents (performing, assisting and observing) are expected to be

present at the OR fifteen (15) minutes prior to the scheduled start of each

surgical procedure, or at the beginning of each operative day.

2. Dress code

The dress code is of a health care professional in an outpatient setting.

This is to the discretion of the resident, but generally indicates a collared

shirt and tie (mandatory for department conferences, official medical center

functions, interhospital functions) for men and the appropriate equivalent for

women. No jeans, sandals, barefoot, or gym wear are accepted. The

prescribed long white coat is to be worn in clinics, in the wards, and on

hospital premises. Also, the official medical center ID must be worn at all

times in the hospital.

3. Operating room

The senior resident must be familiar with the indications, techniques and

complications of the respective procedures.

When operating on outpatient clinic patients: the senior resident must

have personally examined each patient and placed notes in the respective

charts, including justification for surgery, before performing the surgical

procedure.

On completion of his/her tasks in the OR, the senior resident is obliged to

return to the clinic or the ward to assess patients and help the junior residents

with daily clinical functions.

4. Mandatory activities for all residents

Participate in department conferences, postgraduate courses

Attend all teaching rounds and consultants’ lectures. There is a

mandatory 90% attendance required, otherwise the RTO will be notified and

will take the necessary action.

Take the periodic tests and quizzes as administered by the residency

training staff (department consultants) and participate in graded quarterly

oral examinations.

5. Guidelines for on-call (“duties”)

Residents must be within designated area of responsibility and be

immediately accessible to answer calls from various hospital units;


8

Personally examine and verify patients referred to for care, and be

responsible for treatments administered to such;

If with any question regarding emergency management, please call senior

resident and then the consultant staff doctor on-call for appropriate guidance

and disposition.

6. Leave of Absence and Vacation

In order to request a leave, each resident must complete the Leave of

Absence Form provided by the medical center’s Human Resource

Development (HRD) Office. This form must be signed by the Department

Chairman and submitted to HRD for disposition/approval.

Residents are allowed up to two (2) weeks per year of vacation leave and

up to two (2) weeks of certified sick leave per year. Vacation leaves may be

utilized to attend:

1. Scientific conferences, which are priority-determined by seniority.

Remaining residents are to be available to cover the clinics and

emergencies.

2. Marriage Leave

3. Bereavement Leave

Maternity and Paternity leaves shall be awarded in accordance with

guidelines set forth by the Labor Code as adhered to by the medical center’s

HRD office. Emergency leaves shall be approved at the discretion of both

the Department Chairman and the HRD.

It is recommended that leaves of absence to be utilized for the

conferences and marriage leave be applied for at least one month prior to the

intended date. The resident is also responsible for informing the chief

resident to allow for modifications to outlined responsibilities so as not to

disrupt clinic operations.

No two residents will be allowed to go on leave at the same time, either

simultaneously or overlapping, except in emergency situations (as approved

by the both the Department Chairman and the HRD).

The Christmas/New Year and Holy Week periods are not to be

considered as part of eligible vacation time. All residents on the roster for

this period are expected to take their share of call during this time.


D. The Senior Residents

The senior surgical resident (i.e., third year chief or senior resident) is the first

assistant for all cases in the OR. The priority of the senior resident is in the OR.

If there is more than one senior surgical resident, then they are to divide the OR

time among themselves.

Any disputes regarding OR time distribution will be brought to the attention of

the Residency Training Officer who will mediate the dispute.

Senior residents are excused from the first OR case in the morning if they are

attending or presenting at department clinical conferences.

Senior surgical residents are excused from the OR for teaching rounds.

The senior resident is expected to attend the OR if teaching rounds are cancelled.

Senior surgical residents are advised to refer any functionally one-eyed patients

(defined as only one eye with >20/40 potential) to the staff consultant on call for

surgery on the better eye.

The senior surgical resident should work-up any patients from the outpatient

clinic requiring cataract surgery and should have a list of patients ready to be

added to the surgical day (Wednesday mornings).

Any outpatient clinic patients booked for surgery should have their chart

reviewed with the senior consultant on call before surgery. This would include

the biometry and manifest refraction as well as any other pertinent information.

The senior surgical resident should not operate on any patient with moderate to

severe corneal endothelial dystrophy or evidence of split fixation secondary to

glaucomatous visual field loss.

The senior surgical resident is responsible to do all OR operative

records/technique of surgery for the surgeries that they attend/perform. It is their

responsibility to ensure that the records are complete and accurate.

The senior surgical resident is responsible for co-coordinating the resident team.

This would include assigning people to see consults on the ward and reviewing

various problems with the junior residents.

Senior residents should ensure that at the end of the day any examining rooms

used by the residents are neatly organized before the resident departs.


10

The senior resident is expected to attend the clinics when the OR is cancelled or

when another resident is assigned to the OR.

The senior resident should attend the end of the clinic after ORs are complete.

The senior resident(s) is/are required to be available for surgical trauma that goes

to the OR even if he/she/they is/are not on-call.

The senior resident is to assign the junior residents to assist staff with cases in the

Minor OR (e.g.: Oculoplastics, Pterygiums, etc.).

The senior surgical resident should have complete knowledge of any in-patients

admitted to the Ophthalmology service. Patients admitted for several days or

weeks should be seen by the senior surgical resident with the junior resident team

when possible.

The senior resident should report any significant performance problems with

individuals

on the resident team to the Residency Training Officer (RTO). The senior

resident is

encouraged to offer the RTO praise for residents who have been doing excellent

work.

The senior resident should keep a surgical logbook of surgical cases. The

Department will provide the logbook. At the end of each period, a copy of your

logbook is to be submitted to the RTO.

The senior resident is responsible for taking attendance at teaching and

Grand Rounds. He/She also assists the Chief Resident in his/her duties whenever

necessary.

E. The Chief Resident

The Chief Resident represents all residents in general meetings with

consultant staff doctors. He/she is the first person to contact for grievances,

council regarding preparation for exams and basic science courses, including

requests for all leaves of absence. Part of the Chief Residents functions are as

follows:

1. Ensure that conflicts between residents/residents and residents/staff are

2. Prepares rotation schedules and on-call schedules (“duties’)

3. Prepares vacation schedules


F. Subspecialty and Rotation Specific Objective

Section 1 Ophthalmic Plastic & Lacrimal Service

A. Didactic Activities

a. The source of didactic instruction will be the Philippine Board of

Ophthalmology (PBO) Orbit and Ocuplastic competencies and the AAO

Orbit and Ocuplastic series. The orbit/oculoplastic resident rotator must

present one or more chapters per week to the orbit consultant of the

month. All residents are required to attend all

presentations. The orbit/oculoplastic consultant of the month gives a 20

point quiz to all residents at the end of the month based on the topics

presented. A final written exam will be given at the end of the year.

b. The orbit/oculoplastic resident rotator shall present at least once during his

rotation on a tuesday conference an interesting case, topic report ,

or research relating to orbit ( journal, literature review . or

research proposal )

c. The orbit/oculoplastic service consultants shall conduct quarterly

conferences attended by all residents . Topics may cover basic,

diagnostics, medical and surgical , and research related to the

subspecialty.

B. Orbit and Oculoplastic subspeciality referral clinics

a. The resident rotator shall be responsible for all orbit and

oculoplastics service referrals . An in-depth knowledge of the patient's

case is required prior to referring to the consultant.

b. The resident rotator shall be the custodian of all

the orbit/oculoplastic charts and shall ensure complete, organized, and

legible recording and filing.

C. Surgical Competencies

a. The orbit/oculoplastic resident rotator should be able to accomplish the

mandatory requirement of surgical cases by the PBO 2009 guidelines,

before their residency ends. Namely, they are as follows:

i. Lid Surgeries – 4

ii. Tarsorrhapy – 1

iii. Repair of lid laceration – 3

iv. Excision of lid mass (Non-Margin) – 2

v. Enucleation – 1

vi. Evisceration – 1

b. The orbit/oculoplastic resident rotator must assist in the following

procedures, based on the PBO 2009 guidelines, before their residency

ends:


12

i. Dacryocystorhinostomy

ii. Entropion repair

iii. Ectropion repair

iv. Ptosis repair

v. Excision of lid mass (margin)

vi. Exenteration

c. The orbit/oculoplastic resident rotator should have thorough knowledge on

the following procedures as based on the PBO 2009 guidelines:

i. Blepharoplasty

ii. Orbitotomy procedures

iii. Repair of Anophthalmic Sockets

D. Evaluation

a. Final written exam grade = Quiz 50% + Final exam 50%

b. Structured evaluation forms = pass or fail

c. Clinical Performance: Resident’s Performance Evaluation Form

d. Surgical: GRASIS

Section 2 External Disease Service



Ophthalmology External Disease competencies and the AAO External

Disease and Cornea series.

b. The consultant of the month shall give a 10-point quiz to all residents at

the end of the month on prescribed topics. A final written exam will be

given at the end of the year.

c. The resident rotator shall present at least once during his rotation an

interesting case, topic report, or research relating to External

Disease (journal, literature review or research proposal)

B. Reading and interpretation of diagnostic tests

a. The External Disease resident rotator shall be responsible for initial

interpretations of exams done on service patients, including (but not

limited to) the following:

i. Gram Stain

ii. Giemsa Stain

iii. Tests for evaluation of tear film (Tear Break Up Time and

Schirmer’s Test)

b. The resident rotator shall update all laboratory results especially those

concerning microbiology.

c. The External Disease consultant of the month will discuss official

interpretations with the resident rotator.

C. External Disease referral clinics

a. The resident rotator shall


i. Be responsible for all service referrals

ii. Extract a comprehensive history from patients

iii. Perform a thorough external eye exam.

iv. Perform a thorough slit lamp exam.

v. Draw findings completely and accurately

vi. Observe proper specimen collection, handling and transport

techniques

b. When referring to the External Disease Consultant, the resident rotator

shall

i. Present history and findings in a systematic manner

ii. Formulate a working diagnosis

iii. Request appropriate diagnostic and laboratory exams

iv. Suggest treatment plans

v. Prescribe medications and properly give instructions to patients

c. The resident rotator shall be the custodian of all the External

Disease charts and shall ensure complete, organized, and legible recording

and filing.

d. The resident rotator shall maintain smooth and orderly traffic flow in the

clinic and maintain the availability of clinic and office supplies at the

External Disease Clinic.

D. Evaluation




d. Surgical: GRASIS

Section 3 Cornea, Optic and Refractive Surgery Service

A. Didactic activities


Ophthalmology cornea and refractive surgery competencies, the AAO

Refractive Surgery Series, and Cornea Section of The External Disease

and Cornea Series.

b. The Cornea and Refractive Surgery resident rotator must present 1 or

more chapters per week to the Cornea and Refractive surgery consultant of

the month. All residents are required to attend all presentations. Ten to

fifteen-point quizzes will be given after each presentation. A final written

and practical exam will be given at the end of the year.

c. The resident rotator shall present at least once during his/her rotation on a

Tuesday conference an interesting case report or research relating to

Cornea and Refractive surgery

B. Cornea and Refractive Surgery referral clinics

a. The resident rotator shall be responsible for all service referrals. An in-

depth knowledge of the patient’s case is required prior to referring to the

cornea and refractive surgery consultant.


14

b. The resident rotator shall be the custodian of all the cornea and refractive

surgery charts and shall ensure complete, organized, and legible recording

and filing.

c. The surgical cases will be attended by the senior resident

C. Corneal Surgical Activities

a. Corneal surgeries outlined in the PBO curriculum are to be performed by

the senior residents and supervised by the cornea consultant of the month.

The Cornea consultant should assist the residents in case finding during

OPD clinics and Cornea subspecialty referral clinics in order to fulfill the

census required by the PBO.

D. Reading and interpretation

a. The Cornea and refractive surgery resident rotator shall be responsible for

all initial interpretations of Keratometry, A-Scan Biometry, Specular

Microscopy performed on service patients.

b. The cornea and refractive surgery consultant will provide final

interpretation after discussion and feedback with the resident rotator.

E. Evaluation

a. Final written exam grade = quiz 50% + final exam 50%



d. Surgical: GRASIS

Section 4 Uveitis Service



Ophthalmology uveitis competencies, the AAO Uveitis section, and some

lecturettes from the MEEI Uveitis Service. All residents are required to

attend all presentations. The uveiis consultant of the month gives a quiz to

all residents at the end of the month based on the topics presented by

the resident rotator. A final written exam will be given at the end of the

year.

b. All residents are required to attend the uveitis case conferences sanctioned

by the Philippine Ocular Inflammation Society (POIS). Attendance to

90% of the conferences and passing the written final exam are required to

be eligible to pass the Uveitis course.

c. The uveitis resident rotator shall present at least once during his rotation

on a tuesday conference an interesting case, topic report, or research

relating to uveitis (journal, literature review or research proposal)

d. The uveitis service consultant shall conduct quarterly uveitis conferences

attended by all residents . Topics may cover basic, diagnostics, medical

and surgical, and research.

B. Skills Development, Laser and Surgical Activities


a. Skills required to perform a complete and thorough uveitis history and

P.E. shall be given focus. Demo-return demo sessions on history taking,

slit lamp biomicroscopy, grading of cells, flare, vitritis, etc. shall be done

quarterly. Other skills like indirect ophthalnoscopy shall likewise be

further refined and practiced.

b. Lasers and surgeries in uveitis patients outlined in the PBO curriculum are

to be performed by senior residents and supervised by the uveitis

consultant. The uveitis consultant should assist the residents in case

finding during OPD clinics and subspecialty referral clinics in order to

fulfill the census required by the PBO.

C. Reading and interpretation of diagnostic tests

a. The resident rotator shall be responsible for all initial interpretations of

fluorescein angiograms, B-scans and OCT performed on all service and

private patients.

b. The uveitis consultant will provide the final official interpretation after

discussion with and feedback with the resident rotator.

D. Uveitis subspecialty referral clinics

a. The resident rotator shall be responsible for all uveitis service referrals .

An in-depth knowledge of the patient's case is required prior to referring

to the consultant.

b. The resident rotator shall be the custodian of all the uveitis patient’s charts

and shall ensure complete, organized, and legible recording and filing .

E. Evaluation

a. Final written exam grade = Quiz 40% + Final exam 40% + OSCE 20%



d. Surgical: GRASIS

Section 5 Ophthalmic Oncology and Pathology Service

A. Learning Objectives

a. COGNITIVE

i. To apply the basic knowledge of anatomy, physiology and

histology of the eye and ocular adnexae

ii. To explain the pathophysiology of common ocular tumors

iii. To asses clinical information on cases related to ocular tumors

iv. To formulate a management plan (diagnostic and treatment) for

ocular tumor cases

b. PSYCHOMOTOR

i. To perform a complete ocular examination

ii. To perform surgeries involving ocular tumors (TO BE

COORDINATED WITH OTHER SUBSPECIALTIES)

iii. To perform correct specimen handling and slide reading

B. Contents


16

2.1 The source of didactic instruction will be the Philippine Board of

Ophthalmology Syllabus Section VII Ophthalmic Oncology and Pathology.

C. Activities

a. Each resident must present two interesting actual cases of ocular tumors

every year during weekly conferences.

b. Each resident is required to present one case (to be selected by the Section

Head) during the PAO Convention.

c. Residents must appraise pertinent articles or perform literature review on

the latest management (diagnostic and treatment) of ocular tumors.

d. Each resident must attend specimen grossing and slide reading with the

Section Head at least twice a month.

D. Evaluation

a. Written case reports (ocular tumor cases) presented during conferences

will be submitted to the Section Head for grading.

b. Over-all performance will be rated by the Section Head based on the

submitted written reports and performances during rounds with the

Section Head

c. Written examination conducted by the department will include questions

specific to the subspecialty

E. References & Learning Materials

a. Clinical materials (patients)

b. Related journals articles

c. AAO Section 4

d. Teaching slides c/o Section Head

Section 6 Glaucoma Service



Ophthalmology glaucoma competencies, the AAO glaucoma series, and

the glaucoma curriculum of the University of IOWA /

iowa glaucoma Center ( http://curriculum.iowaglaucoma.org/sections )

The glaucoma curriculum of the University of IOWA consists of fifty (50)

10minute video chapters. The glaucoma resident rotator must present one

ore more chapters per week to the glaucoma consultant of the month. All

residents are required to attend all presentations. The glaucoma consultant

of the month gives a 10 point quiz to all residents at the end of the month

based on the topics presented by the glaucoma resident rotator. A final

written exam will be given at the end of the year.

b. As part of the MOA between UERM and AEI, All residents are required

to attend the glaucoma bimonthly conferences at the Asian Eye

Institute. Attendance to 90% of the conferences and passing the written

final exam are required to be eligible to receive a certificate.

http://curriculum.iowaglaucoma.org/sections


c. The glaucoma resident rotator shall present at least once during his

rotation on a tuesday conference an interesting case, topic report ,

or research relating to glaucoma ( journal, literature review . or

research proposal )

d. The glaucoma service consultants shall conduct

quarterly glaucoma conferences attended by all residents . Topics may

cover basic, diagnostics, medical and surgical , and research related

to glaucoma.

B. Laser and surgical activities

a. Glaucoma lasers and surgeries outlined in the PBO curriculum are to be

performed by senior residents and supervised by the glaucoma consultant

of the month. The Glaucoma consultant should assist the residents in case

finding during OPD clinics and glaucomasubspecialty referral clinics in

order to fulfill the census required by the PBO.

b. As part of the MOA with OFPHIL and AEI, senior residents may be

required to perform and or assist glaucoma surgeries and lasers supervised

by the glaucoma consultant affiliated with the said institutions.

C. Reading and interpretation of glaucoma diagnostic tests

a. The glaucoma resident rotator shall be responsible for all initial

interpretations of visual field exams and OCT performed on all service

and private patients.

b. The glaucoma consultant of the month will provide the final official

interpretation after discussion with and feedback with the resident rotator.

c. Neuroophtha visual fields shall also be interpreted by the resident rotator

and referred to the N-O service consultant for final official reading.

d. Serial fields performed on private patients shall be referred to

the glaucoma consultant who provided the previous reading unless

otherwise specified by the requesting physician.

D. Glaucoma subspecialty referral clinics

a. The resident rotator shall be responsible for all glaucoma service referrals .

An in-depth knowledge of the patient's case is required prior to referring

to the glaucoma consultant.

b. The resident rotator shall be the custodian of all the glaucoma charts and

shall ensure complete, organized, and legible recording and filing .

c. As part of the MOA with OFPHIL, the resident rotator shall be required

to be present and arrive on time for the glaucoma consultation clinic at the

OFPHIL San Juan Clinic held every Tuesday from 1030AM - 1230PM.

E. Evaluation




18


d. Surgical: GRASIS

Section 7 Retina and Vitreous Service



Ophthalmology retina competencies, the AAO retina and vitreous series

and ICO Residency Curriculum.

b. The retina and vitreous resident rotator shall present at least once during

his rotation on a Tuesday conference an interesting case, topic report ,

or research relating to glaucoma ( journal, literature review . or

research proposal )

c. The retina and vitreous service consultants shall conduct monthly retina

and vitreous conferences attended by all residents. Topics may cover

basic, diagnostics, medical and surgical, and research related to retina and

vitreous.

B. Laser and surgical activities

a. Retina and vitreous lasers and surgeries outlined in the

PBO curriculum are to be performed by senior residents and supervised by

the retina and vitreous consultant of the month. The retina and vitreous

consultant should assist the residents in case finding during OPD clinics

and retina and vitreous subspecialty referral clinics in order to fulfill the

census required by the PBO.

C. Reading and interpretation of Retina and vitreous diagnostic tests

a. The retina and vitreous resident rotator shall be responsible for all initial

interpretations of fundus photo, fluorescein angiography and macular OCT

performed on all service and private patients.

b. The retina and vitreous consultant of the month will provide the final

official interpretation after discussion with and feedback with the resident

rotator.

D. Retina and vitreous subspecialty referral clinics

a. The resident rotator shall be responsible for all retina and vitreous service

referrals. An in-depth knowledge of the patient's case is required prior to

referring to the retina and vitreous consultant.

b. The resident rotator shall be the custodian of all the retina and vitreous

charts and shall ensure complete, organized, and legible recording and

filing.


E. Evaluation




d. Surgical: GRASIS

Section 8 Pediatric Ophthalmology and Motility Service



Ophthalmology pediatric ophthalmology competencies.

b. A monthly pediatric ophthalmology/strabismus focus group discussion

will be scheduled and all residents are required to attend all FGDs.

The consultant of the month gives a 10-point quiz to all residents at the

end of the month based on the topic discussed. A final written exam will

be given at the end of the year.

c. The resident rotator shall present at least once during his rotation on a

Tuesday conference an interesting case, topic report, or research relating

to pediatric ophthalmology/strabismus (journal, literature review or

research proposal)

d. All residents are required to attend PSPOS sponsored strabismus

conferences and LEAP programs.

B. Pediatric Ophthalmology & Strabismus referral clinics


depth knowledge of the patient's case is required prior to referring to

the Pediatric Ophthalmology & Strabismus consultant.

b. The resident rotator shall be the custodian of all the Pediatric

Ophthalmology & Strabismus charts and shall ensure complete, organized,

and legible recording and filing.

c. Surgical cases will be attended by the assigned senior resident.

C. Evaluation




d. Surgical: GRASIS

Section 9 Neuro-Ophthalmology and Visual Electrophysiology Service



Ophthalmology neuro-ophthalmology competencies and the AAO neuro-

ophthalmology series.

b. All residents are required to attend the neuro-ophthalmology bimonthly

conferences at Clinica Tamesis. The consultant of the month gives a 10-

point quiz to all residents at the end of the month based on the topic

discussed. A final written exam will be given at the end of the year.


20

c. The resident rotator shall present at least once during his rotation on a

Tuesday conference an interesting case, topic report, or research relating

to neuro- ophthalmology (journal, literature review or research proposal)

d. All residents are required to attend Neuro-ophthalmology club RTD and

LEAP programs.

B. Reading and interpretation of neuro-ophthalmology diagnostic tests

a. The neuro-ophthalmology resident rotator shall be responsible for all

initial interpretations of visual field exams related to neurology cases on

all service and private patients.

b. The neuro-ophthalmology consultant of the month will provide the final

official interpretation after discussion with and feedback with the resident

rotator.

C. Neuro-Ophthalmology referral clinics


depth knowledge of the patient's case is required prior to referring to

the Neuro-Ophthalmology consultant.

b. The resident rotator shall be the custodian of all the Neuro-

Ophthalmology charts and shall ensure complete, organized, and legible

recording and filing.

D. Evaluation




d. Surgical: GRASIS

Section 10 Cataract Service

Training in the Lens and Cataract section may be considered as one of the strong points of Residency Training Program of the UERM Department of Ophthalmology. The Consultants, headed by the Chair of the Cataract Section, oversee the development of each resident in terms of knowledge, skill, and attitude. Residents are exposed to a variety of ECCE and Phacoemulsification techniques by assisting our consultants in their early training, then they are supervised by the consultant staff in the wet lab and undergo rigorous didactics and oral examinations prior to performing their first ECCE(beginning of second year), and again undergo the same for their first Phaco (beginning of third year). The UERM Lens and Cataract Training Program acknowledges a few major references in the setting of guidelines for consultants who contribute to the residents' cataract training. These are:

Cataract Surgery for Greenhorns by Dr. Thomas Oetting (University of Iowa,

2012)


International Council of Ophthalmology Residency Curriculum (2012)

Philippine Board of Ophthalmology Residency Training Curriculum

COMPETENCIES OF CATARACT SURGERY TRAINING

1st Year Gain good basic knowledge and understanding of ECCE and Phacoemulsification

Cataract Surgery

Assist Consultants and their Senior Residents in all cases of Cataract Surgery at

the Center.

Master operation and troubleshooting of the operating microscope, phaco

machine, fast autoclave, and all ophthalmic instruments and supplies used in

cataract surgery

Facilitate patient education in the outpatient clinic on the development of

cataracts and their signs and symtoms as well as the proper indications for

cataract surgery

Perform patient screening and instituting care of of cataract patients from the

outpatient clinic to the ward and operating room

Facilitating referrals to anesthesia, internist, neurologist, or any other specialty

necessary and relevant for each patient in the preparation for a patients's cataract

surgery (ie ASA, MRA, Neuro Clearance, Endo Clearance, etc.)

Facilitate proper consent procurement for cataract surgeries (verbal and written)

Facilitate complete documentation written and/or video of cataract surgeries

Perform postoperative evaluations post-cataract surgery and to identify any

complications specific to the number of days or weeks until 2 months postop.

Perform peritomy, wound construction, capsulotomy, and suturing on pig eyes at

the wet lab sessions

Perform post cataract refraction for post op patients (even up to years after

surgery)

2nd Year

Comprehensive knowledge and understanding of ECCE and Phacoemulsification

Assist the consultants and their senior residents in all cases of Cataract Surgery at

the Center

To identify ideal candidates for planned ECCE in their first few cases (difficult

cases to be performed during later stages of second year or by third year residents)

To be able to perform good planning of surgeries i.e. type of anesthesia, selection

of surgical technique, placement of incisions and sutures, preparation of backup

lenses and devices, etc.

Be able to perform 10 ECCEs with direct supervision by the consultants (GRASIS

form)

Have knowledge on troubleshooting and mitigating of complications of ECCE

3rd Year

Have thorough knowledge and understanding of ECCE and Phacoemulsification


22

Cataract Surgery

Perform 10 or more Phacoemulsification Cases under direct supervision by the

consultants (GRASIS form)

Perform difficult ECCE cases if not suitable for second year residents

Be able to plan and perform cataract surgery for patients with glaucoma, uveitis,

previous eye procedure, laser/ refractive surgery or trauma, or any other

potentially difficult cataract surgery

Perform Manual Small Incision Cataract Surgery (MSICS)

Be knowledgeable in the indications and use of multifocal, accommodative, toric,

suture fixated, and anterior chamber intraocular lenses

Be able to intervene appropriately and quickly in preop, intraop, or postop events

or complications of any cataract surgery with guidance of the consultants

Timely referrals to consultants, subspecialists, or other medical specialties in

these case of the said emergencies

Evaluation

o Final written exam grade = Quiz 50% + Final exam 50%

o Structured evaluation forms = pass or fail

o Clinical Performance: Resident’s Performance Evaluation Form

Surgical: GRASIS

G. Performance Criteria

The following are the minimum requirements that a resident must

accomplish to qualify as having completed the residency program and enable

him to take the PBO Ophthalmology certifying board examination (written and

oral portions). It is required that residents keep a daily logbook of these

activities (provided by the PBO) while in training.

1. Formal lecture in basic ophthalmology - the resident must present a

certificate of attendance from an accredited basic course lecture series.

2. Refraction and out-patient cases - the resident must have treated at least

1000 cases during his/her training period.

3. Case presentation - the resident must submit a synopsis of 10 interesting

cases encountered during his/her training period.

4. “Should do” surgeries - the resident must submit the name, age, address

and the hospital number of the patient, date of operation, type of operation

5. “Should assist” surgeries - the resident must submit the name, age,

address and the hospital number of the patient, date of operation, type of

operation, name of main surgeon

6. “Should comprehend” surgeries - the resident must obtain a certification

from the chairman that these types of surgeries have been observed in

person or through video.

7. The resident must report all his scientific presentations in the space

provided in the logbook. In addition, he/she must submit the full text of his


care report, a retrospective study and a prospective study done during the

tenure of his/her training.

8. Scientific conference - the resident must attend one major scientific

conference of the Philippine Academy of Ophthalmology and two other

ophthalmology postgraduate courses during his training period. This shall

be exclusive of the regular department conference and meetings. The

resident must present the certificates of attendance.

H. Performance Assessment

Quarterly formative evaluations

Annual summative evaluation (including recommendation for promotion or

removal)

1. Accumulated test scores

2. Surgical assessment

3. Participation during clinical rounds

4. Compliance with requirements for promotion (clinical conference

presentations, case presentations, research output)

5. Attitude and behavioral assessment

Examinations:

6. Subspecialty quizzes (10-15 points/MCQ)- to administered by

subspecialty section consultant staff

7. Periodic quizzes in general ophthalmology (10-15 points/MCQ) - on

topics appointed by the RTO or assistant RTO

8. Quarterly oral examinations - on subspecialty topics covered during

recent quarter; administered by consultant staff

9. OPEX - administered July of each year by the UP-PGH Department of

Ophthalmology and Visual Sciences

10. PBO-RTO subgroup examinations - per schedule; to be administered

online

Conference Presentation Evaluations

Global Rating Assessment in Intraocular Surgery (GRASIS) Ophthalmic Clinical

Evaluation Exercise (OCEX)

PART V. HOSPITAL POLICIES and Regulation

In relation to offenses, incident reports, disciplinary sanctions, leave policy, grievance

procedures, inclement weather and other emergencies, the Department of Ophthalmology

strictly adheres to the policies and regulation of the UERMMMCI Hospital as stated in the

UERMMMCI House Staff Policies Rules and Regulation 2013-2014 manual.


24

PART VI. APPENDIX

A. Global Rating Assessment in Intraocular Surgery


B. Resident’s Performance Evaluation Form

! !

Resident’s)Performance)Evaluation)Form!!!

Ophthalmology)Resident)Evaluation)Form)!!!!Resident:! Level!of!training:!1st!yr!!2nd!yr!!3rd!yr!

!

Date!of!rotation:! to! !!!!!!!!!!!!!!!!!!!!!Date!of!evaluation:!

Rotation:! Evaluator(s):!

Frequency!of!interaction!with!this!particular!resident:!!!!!!!!! >!twice!a!week!! once!a!week!

twice!a!month!!! <!once!a!month!!

Check!either!one!or!both!of!the!following:!!

This!evaluation!summarizes! the!resident’s!performance!at!the!end!of!this!rotation.!!

This!evaluation!!includes! a!direct!observation!!of!a!patient! clinical!&!/!or!surgical! encounters!!conducted!!by!

this!resident.!

!

!Note:&Encircle&the&appropriate&rating&per&item.&Evaluation&levels&below&“4”&require&comment.!

!

!I. Patient Care!

General!competency:!!Resident!must!be!able!to!provide!care!that!is!compassionate,!!appropriate,! and!effective! for!the!

treatment!of!health!problems,!and!the!promotion!of!health.!!

!

I>A.)Clinical)Skills!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Below!expectations!!!!!!!!!!!!!Expected!level!!!!!!!!!!!Exceeds!expectations!

1. Gathers!essential!information! ! !!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

2. Displays!mastery!of!examination! skills! !!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

3. Formulates! through!differential!diagnosis! !!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

4. Develops!&!initiates!appropriate!management!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

5. Effectively!counsels!and!educates!patients! !!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

6. Utilizes!auxiliary!resources!! ! !!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

!

Comments:! !

!!!!!

I>B.)Surgical)Skills!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Below!expectations!!!!!!!!!!!!!Expected!level!!!!!!!!!!!Exceeds!expectations!

7. Enables!logical!preoperative! decisionZmaking! !!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

8. Adequately! informs!patients!of!risks,!benefits,!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!! ! and!alternatives! to!procedure! !!!!!!

9. Demonstrates! sound!intraoperative! judgment!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

10. Displays!technical!surgical!competence! !!!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

11. Provides!appropriate!postoperative! care,!!!! !!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!! including!management!of!complications! !!!!!

12. Maintains!surgical!log! ! ! !!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!


26

! !

II. Medical Knowledge!!

General!!Competency:!!Resident!!must!!demonstrate!!knowledge!!about!!established!!and!!evolving!!biomedical,!!clinical,!

and!cognate!(e.g.!epidemiological! and!socialZbehavior)!!sciences!and!the!application!of!the!knowledge!to!patient!care.!

!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Below!expectations!!!!!!!!!!!!!Expected!level!!!!!!!!!!!Exceeds!expectations!!

13. Applies!knowledge!of!basic!&!clinical!sciences!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

14. Demonstrates! analytical!thinking! ! !!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

!!!Comments:!

!

!!!!!

III. Professionalism!!

General!! Competency:!!!Resident!!!must!!demonstrate!!!a!!commitment!!!to!!carrying!!!out!!professional!!!responsibilities,!

adherence!to!ethical!principles,!and!sensitivity!to!a!diverse!patient!population.!

!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Below!expectations!!!!!!!!!!!!!Expected!level!!!!!!!!!!!Exceeds!expectations!!

15. Behaves!respectfully!and!compassionately!!!!!!!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

16. Sensitive!to!cultural/age/gender/disability!!!! ! !1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!!!!!!!!!!!!issues!17. Fulfills!assigned!clinical!and!onZcall!!! !!! !1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

!!!responsibilities!18. Displays!professional!ethics!! ! !!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

!!!

!

Comments:! !

!!!!!

)

)

IV. Practice>Based Learning and Improvement!!

General!!Competency:!!Resident!!must!be!able! to! investigate!!and!evaluate!!his!or!her!patient! care!practices,!!appraise!

and!assimilate!scientific!evidence,!and!improve!patient!care!practices.!

!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Below!expectations!!!!!!!!!!!!!Expected!level!!!!!!!!!!!Exceeds!expectations!

19. Uses!evidence!from!ophthalmic! literature!!!!!!!!!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

20. Utilizes!information! technology!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

21. Teaches!students,!staff,!and!colleagues!!!!!!!!!!!!!!!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

22. Continually! improves!practice!based!on!!!!!!!!!!!!!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!!!! !!!!past!experience!


!

V. Interpersonal and Communication Skills!!

General!!Competency:!!Resident!!must!be!able! to!demonstrate!!interpersonal!!and! communication!!skills! that! result! in!

effective!information!exchange!and!teaming!with!patients,!their!families,!and!profession!associates.!

!

!Below!expectations!!!!!!!!!!!!!Expected!level!!!!!!!!!!!Exceeds!expectations!

23. Establishes! therapeutic!relationship! ! ! ! ! !1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!! ! ! ! ! ! ! ! !with!patient!24. Interacts!well!with!staff,!faculty,!! ! !!!! !1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

!!!!!and!colleagues!25. Displays!effective!listening!skills! ! !!!!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

26. Maintains!timely!and!legible!medical!records!!!!!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

27. Presents!patients!effectively!and!succinctly!! !!!!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

!!!Comments:!

!

!!!!!

VI. Systems>Based Practice!

General!!Competency:!!Resident!!must!!demonstrate!!an!!awareness!!of! and!!responsiveness!! to! the!!larger!!context!!and!

system!of!health!care!and!the!ability!to!effectively!call!on!system!resources!to!provide!care!that!is!of!optimal!value.!!!

Below!expectations!!!!!!!!!!!!!Expected!level!!!!!!!!!!!Exceeds!expectations!

28. Practices!costZeffective! care!!!!!!!! ! !!!!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

29. Collaborates!with!other!health!care!providers!!!!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!

30. Acts!as!advocate! for!patient!within!! ! !!!!!1!!!!!!!!!!!!2!!!!!!!!!!!!3!!!!!!!!!!!!4!!!!!!!!!!!!5!!!!!!!!!!!!6!!!!!!!!!!!!7!!!!!!!!!!!!8!!!!!!!!!!!!9!!!!!!!!!!!!NA!!!!!!!!!!!!!!health!care!system!!

!!!!

Comments:! !!!!

!Final)Comments)/)Summation!

!!!!!!!

Suggested!! Remediation/Corrective!!Measures!! (Journal!!presentation/review!!of!!current!! literature,!! lecture/report,!!

written/oral! examinations,! surgical!wetZlab/video,! etc.):!!!!!!!!

Signature!of!Evaluator:! Date:!

!

The!! Evaluator,!!!Head!!!of!! Service/Program!!!Director!!!and!! the!! resident!!!have!!met!! and!! discussed!!!this!! evaluation!personally.!

!!

Resident!! Head!of!Service!! Residency!Training!Officer!! Date!


28

C. UERM Department of Ophthalmology Resident Training Manual 2010

Subspecialties and Rotation Specific Objectives

Ophthalmic Plastic & Lacrimal Service

First Year Resident

Knowledge

1. Basic ophthalmic anatomy

2. Basic ophthalmic physiology

3. Basic ocular exams

4. Basic ophthalmic Plastic-Lacrimal

exams

5. Ophthalmic PL clinical diseases and

management

6. General OR guidelines on asepsis

sterility

7. Basic principles of ophthalmic plastic

and reconstructive surgeries

Skills

1. History taking, PE ocular exam

2. PL exams (LAI, levator function, Jone’s

test, etc.)

3. Special PL exams (DCG, CT-Scan,

MRI, etc.)

4. Surgical procedures

a. excision of small size

masses/benign tumors (<10 mm)

of conjuctiva and lids (not

affecting the margin)

b. I and C/I and D

c. Enucleation

d. Evisceration

e. Lacrimal probing

f. Repair of lid laceration without

lid margin involvement

g. Surgical instruments

familiarization

h. Surgical asepsis/antisepsis

technique

Second Year Residents

Knowledge

1. Ophthalmic pathology

2. Ophthalmic Plastic Lacrimal problems

and its management

a. Eyelash problems (distichiasis,

trichiasis)

b. Eyelid malposition (entropion,

ectropion, lid malposition)

c. Eyelid colobomas (congenital,

traumatic)

d. Benign eyelid tumors

e. (Hemandiomas/lymphangiomas

,

neurofibromas, lipomas,

syringoma, nevi,

chalazion/hordeola

f. Malignant eyelid tumors (Basal

cell CA, squamous cell CA,

Meibornian, metastasis, etc.)

g. Miscellaneous lid problems

(Blepharophimosis syndrome,

Pseudo-Grafe syndrome,

simple/complicated lid traumas)

Skills

1. Gross pathology exam

2. Clinical microscopic pathologic exam


a. excision of moderate size

masses/tumors (>11 mm, <20

mm) of conjunctival and lids

(with or without lid margin

involvement

b. repair of lid laceration (with or

without lid margin involvement)

c. repair of lid avulsion (without

tissue loss)

d. repair of canalicular transection

e. lacrimal intubation / probing lid

shortening procedures

f. Dacryocystectomy

g. Punctuplasty

h. Cryosurgery of eyelashes

deformities


h. Conjunctival problems

(pterygium Conjunctival cyst,

nevi, squamous cell CA

Malignant melanoma,

metastatic)

i. Orbit wall problems (blow-out

fracture, maxillary bone defects,

associated with craniofacial

defects, general contraction of

the orbit, superior sulcus

deformity, interior fornix

shallowing, migration of orbital

implants

j. Lacrimal excretory problems,

punctal, canalicular, lacrimal

sac, nasolacrimal duct)

k. Cosmetic eyelid problems

(baggy eyelid, dermatochalasis,

blepharochalasis, Malar

Festoon, brow prosis, sagging

face syndrome)

Third Year Residents

Knowledge

1. Indications / contraindications of PL

procedures

2. Complications and management of PL

procedures

3. Lid retraction surgeries (with/without

grafts)

4. Blepharoptosis surgeries

(with/without slings)

5. Contracted orbital surgeries

(with/without tissue graft)

6. Eyelid reconstructions (with/without

tissue grafts)

7. Medical/Lateral

canthoplasties/canthothomies

(including epicanthal fold defects)

8. Tissue grafting (skin, hard palate,

sclera, ear cartilage, nasal septum

cartilage, fascia lata, dermal fat,

buccal mucosa, conjunctivae, tarsus)

9. Orbital wall surgeries (with/without

plating/grafting)

10. Cosmetic surgeries (Blepharoplasty,

brow lift, face lift)

Skills


a. repair of lid avulsion with/without

tissue loss

b. repair of canalicular transection

(complicated)

c. Dacryocystorhinostomy

(with/without silicone intubation)

d. Distichiasis surgeries (with/without

tissue grafts)

e. Trichiasis surgeries (with/without

tissue grafts)

f. Ectropion surgeries (with/without

tissue grafts)

g. Entropion surgeries (with/withou

tissue grafts)

Suggested Readings:

1. Byron C. Smith’s Ophthalmic Plastic and Reconstructive Surgery (Vol. 1 and 2) (ed.

Robert C. Della Rocca, Frank A. Nesi, Richard D. Lisman) 1987

2. Repair and Reconstructive in the Orbital Region. (ed. John Clarke Mustarde) Third


30

Edition, 1991

3. 3. Any Ophthalmic Anatomy Book

4. 4. AAO, Basic and Clinical Science Course Section on Plastic Lacrimal

Orbit Service

First Year

Knowledge

1. Orbital Anatomy and Physiology

2. Evaluation of orbital disorders

3. Differential diagnosis according to

clinical manifestations

4. Classification of orbital diseases

according to age, tissue origin, location

5. Radiology of the Orbit (plain film, CT,

MRI)

Skills

1. Detailed history taking relevant to

orbital diseases

2. Gross inspection of clinical

manifestations of orbital diseases

3. Exophthalmometry

4. Palpation around the globe

(detection of increased resistance

to retrodisplacement, pulsations

5. Auscultation with stethoscope


Knowledge

1. Distrinct features of orbital diseases

a. Orbital cellulitis

b. Preseptal cellulitis

c. Capillary/cavernous

d. Lymphangioma

e. Dernoid/epidermoid cyst

f. Optic nerve glioma/meningioma

g. Neurofibronmatosis

h. Schwannoma

i. Leukemia/lymphoma

j. Orbital inflammatory syndrome

k. Thyroid related ophthalmopathy

l. Lacrimal tumors

m. Rhabdomyosarcoma

n. Metastic tumors

2. Clinical course of orbital diseases

3. Pathology of orbital disease

4. Treatment options (medical/surgical)

Skills

1. Biopsy techniques

2. Deliver proper patient education,

explaining the nature of the

disease and presenting different

options of management


Knowledge

1. Orbital Surgery

a. surgical spaces

b. anterior/lateral orbitotomy

c. orbital decompression

d. exenteration

2. Treatment protocols for different orbital

disease

a. orbital cellulitis preseptal cellulitis

b. capillary hemangioma

c. orbital inflammatory disease

d. Thyroid related orbitopathy

e. lacrimal gland fossa masses

Skills

1. Management of orbital disease

based on present clinical findings

and on the treatment protocols

2. Recognize medical from surgical

cases

3. Assist in exenteration and post-op

care

4. Assist in anterior/lateral

orbitotomy, orbital decompression

5. Enucleation

6. Emergency repair of orbital floor

fractures


f. orbital trauma

3. Complications of orbital surgery

Suggested Readings:

1. AAO, Basic Clinical and Science Course, Section on Orbit, Eyelids and Lacrimal

2. Diseases of the Orbit by Jack Rootman

External Disease Service

First Year Residents

Knowledge

1. Definition of terms used in external

diseases particularly those pertaining to

clinical changes of the external eye and

cornea

2. Gross anatomy and histology of the

anterior segment (eyelids, cornea,

conjunctiva, sclera)

3. Physiology and biochemistry of the

anterior segment

4. Structure and function of the ocular

surface and tear film

5. Immunology of the ocular surface

6. Response of the anterior segment to

disease and inflammation

7. Response of the anterior segment to

disease and inflammation

8. Principles of ocular pharmacology

9. Ocular microbiology (virology,

lacteriology, mycology, parasitology) and

cytology

10. Defense mechanisms of outer eye

11. Normal ocular flora

12. Pathogenesis of ocular infection

13. Embryology of anterior segment and

common congenital anomalities

14. Recognition of common external eye

diseases

a. Staph, Blepharitis

b. Angular blepharitis

c. Hordeolum and chalazion

d. Adenoviral conjunctivitis

e. Inclusion conjunctivitis

f. GC conjunctivitis

g. Ophthalmia neonatorum

h. Actinic conjunctival granuloma

i. Allergic conjunctivitis

j. Pterygium

k. Pinguecula

l. Simple dry eye syndrome

m. herpes simples keratitis

n. herpes zoster ophthalmicus

Skills

1. Extract comprehensive history

from a patient with external

disease problems

2. Perform through external eye

exam

3. Perform through slit-lamp exam

4. Interpretation of dye staining

pattern

5. Perform tests for evaluation of

tear film (Schimer’s tear break-up

time)

6. Perform Seidel’s test

7. Draw findings completely and

accurately

8. Do gram’s stain

9. Do Giemsa’s stain

10. Proper specimen collection,

handling and transport techniques

(scrapping, AC and Vit. tap)

11. Proper inoculation and culture

techniques

12. Interpretation of smears and

culture results

13. Present history and findings in a

systematic manner

14. Formulate working diagnosis

15. Request appropriate diagnostic

and laboratory exam

16. Suggest treatment plans

17. Prescribe medications properly

18. Give instruction to patient

properly

19. Refer difficult cases properly

20. Injection of traimcinolone (KI)

21. Removal of foreign bodies from

the ocular surface

22. Incision and curettage of

hordeolum and chalazion

23. Excision of pterygium

24. Evisceration

25. Repair of conjunctival laceration


32

o. pseudomonas, streptococcal and

moraxella keratitis

p. fungal keratitis

q. phlyctenulosis

r. welder’s keratitis

s. toxic keratitis

t. scleritis

u. bullous keratopathy

v. hyphema

w. subconjunctival hemorrhage

x. chemical burn

y. ocular surface tumors

15. Surgical principles of I & C pterygium

excision, repair of conjunctival laceration

and evisceration

26. Removal of sutures

27. Reconstitute and prepare fortified

antibiotics including amphotericin

B

28. Assist second and third year

residents in their surgeries

29. Fill up ED form properly

30. Assist consultant in photography

31. Maintain smooth and orderly

traffic flow in the clinic

32. File and keep patient’s records

properly

33. Maintain availability of clinic and

office supplies at ED Clinic

34. Update all laboratory results

especially those concerning

microbiology


Knowledge

1. Pathogenesis, pathophysiology,

diagnosis, differential diagnosis and

treatment of the following conditions:

a. Ocular surface diseases meibomian

gland dysfunction, seborrheic

blepharitis, chalazion, hordeolum,

lymphangiectasia, dry eye

syndromes, Vit. A deficiency,

neorotropic keratopathy, superior

limbic keratoconjunctivitis, recurrent

corneal erosions, persistent epithelial

defect, dellen contact lens

complication, actinic conjuctival

granuloma

b. Infectious diseases – adenoviral

keratoconjunctivitis. Herpes simplex

blepharitis, conjunctivitis, epithelial

and stromal keratitis. Varicellazoster

virus dermatoblepharitis,

conjunctivitis, keratitis, iritis,

scleritis, staphylococcal blepharitis,

fungal and parasitis infection of the

eyelid margin, bacterial conjunctivitis

in neonate, children and adults (GC,

Hemophilus, streptococcal)

chalamydial conjunctivitis, TB

conjunctivitis, Pseudomonas,

Pneumococcal, and Moraxella

keratitis, microbial scleritis,

endophthalmitis, panophthalmitis,

preseptal cellulitis, dacroadenitis,

dacryosititis, orbital cellulitis

Skills

1. Formulative working diagnosis

and differential diagnosis

2. Formulative management plans

3. Institute proper therapeutic

regimen

4. Conjunctival biopsy

5. Tarsorrhaphy

6. Conjunctival flap

7. Superficial keratectomy

8. Corneal biopsy

9. Glue application

10. Paracentesis

11. AC reformation

12. Conjunctival resection

13. Punctal occlusions


c. Immune-mediated diseases – contact

dermatitis, atopic dermatitis, hay

fever and perennial allergic

conjunctivitis, vernal

keratoconjunctivitis, contact lens

induced conjunctivitis, Stevens-

Johnson syndrome, ocular cicatrical

pemphigold, phlyctenulosis,

padikeratitis, idiopathic disciform

keratitis, interstitial keratitis,

marginal corneal infiltrates,

peripheral ulcerative keratitis

Moorens ulcer episcleritis scleritis,

anterior (?)

d. Neoplastic disorders epithelial

inclusion cyst, papilloma,

intraepithelial neoplasia, squamous

cell carcinoma, freckle, ocular

melanocytosis, (nerve?) primary

acquired melanesis, melanoma,

hemangioma, lymphangioma,

lymphoid hyperplasia, lymphoma,

dermoid cyst, dermolipoma

e. Congenital anomalies of cornea and sclera –

microphthalmos,

nanophthalmos, microcornea,

megalocornea, cornea, plana,

axenfeld, reiger peter’s ICE,

sclerocornea, CHED, intraurine

keratitis, birth trauma

f. Corneal cystrophies and metabolic

disorders anterior, stromal, posterior

dystrophies, ecstatic disorders

(keratoconus, keratoglobus, pellucid),

metabolic disorders with corneal

changes

g. Degenerative Disorders – pinguecula,

pterygium, concreations, coals white

ring, spheroidal, limbal girdle, arcus,

crocodile shagreen, cornea farinate,

senile furrow degeneration,

Salzmann, amyloid, corneal keloid,

lipid keratopathy, calcific band

keratopathy, Hassal-Henle bodies

h. Drug induced deposition and

pigmentation – verticillata,

ciprofloxacin, iron deposits, senile

plaques

i. Toxic and traumatic disorders –

thermal, UV, radiation burns,


34

chemical burns, concussive trauma,

nonperforating mechanical trauma,

perforating trauma. Surgical trauma

2. Principle of anterior segment surgery


Knowledge

1. Indications, techniques, complications,

pre-op preparation and post-op care of

the following surgeries

a. Patch graft

b. Lamellar graft

c. Scleral graft

d. Oversize graft

e. Pterygium excision with conjunctival

graft

f. Conjunctival flaps

g. Anterior vitrectomy

h. Iridoplasty

i. ICCE

j. Penetrating keratoplasty

k. Removal of intracameral foreign

body

l. Irrigation of anterior chamber for

hyphema

m. Conjunctival resection

n. Excision and cryotherapy of ocular

surface neoplasia

o. Punctual occlusions

p. Membranectomy

q. Synechiolysis

r. Peripheral and sector iridectomy

s. Yag vitreolysis

t. Laser pupilloplasty

u. Yag capsulotomy

2. Principles of ocular surface

reconstruction

3. Medical and surgical management of all

conditions listed above (second year)

Skills

1. Prepare comprehensive

management plan for ED patient

2. Formulate rational surgical plan

and goals of surgery

3. Prepare all operative needs

4. Be able to refer to consultant

properly

5. Establish rapport with patient and

family

6. Explain risk, benefit and

alternatives to patient adequately

7. Supervise and assist his junior

residents in the performance of their functions

8. Assist consultants and fellows in

their surgeries

9. Perform all procedures listed

above

Suggested References:

1. External Disease and Cornea, Section 2 of Basic and Clinical Course, 1998-99 AAO

2. Infectious of the Eye by Tabbara

3. Diseases of the External Eye and Adnexa by Ostler

4. Twenty year survey of External Eye Diseases by Valenton et al, PJO

5. Ocular infection and Immunology by Pepose, Holland and Wilhelmus

6. The Cornea by Smolin and Thoft

7. Cornea Vols. I Te III by Krachmer, Mannis and Holland

Cornea, Optic and Refractive Surgery Service


Knowledge Skills:


1. Definition of terms used in corneal

diseases

2. Gross anatomy and histology of the

cornea

3. Normal measurements of the cornea

(diameter, shape, thickness, index of

refraction, radius of curvative,

endothelial cell count, etc.)

4. Physiology and biochemistry of the

cornea

5. Molecular biology of the cornea

6. Corneal metabolism

7. Theories on corneal transparency

8. Corneal wound healing

9. Corneal response to inflammation

10. Principles of optics (physical, geometric,

physiology, neuro-ophthalmology)

11. Principles of refraction (streak and

automated)

12. Definitions of the different types of

ametropia

13. Principles of presbyopia

14. Principles of spectacle prescription

15. Principles of corneal transplantation and

eye banking

16. Principles of history taking and

examination of patients with corneal

diseases

17. Principles in the diagnosis and

management of common OPD corneal

problems (congenital corneal

anomalies/opacities, acquired corneal

anomalies/opacities, corneal dystrophies

and metabolic disorders, corneal

degeneration, corneal deposits)

18. Principles in the diagnostic and

management of common ER corneal

problems (abrasions, lacerations,

perforations, UV burn, thermal burn,

chemical burn, foreign bodies)

19. Principle of slit lamp biomicroscopy

20. Principles of keratometry and corneal

topography

21. Principles of specular microscopy

22. Principle of pachymetry

1. Extract a comprehensive history

from a patient with corneal

problems

2. Perform thorough eye

examination with particular

attention to corneal findings

3. Perform thorough slit lamp

examination with appropriate use

of dyes, measurement of lesions,

estimating corneal thickness and edema,

grading of DM folds,

depth of lesion, lighting technique

4. Interpretation of dye staining

pattern

5. Be able to draw corneal findings

completely and accurately

6. Fill up protocol completely and

accurately

7. Present patient’s history and

examination findings in a

systematic manner

8. Formulate working diagnosis

9. Request appropriate laboratory

and diagnostic examinations

10. Suggest treatment plans

11. Prescribe medications properly

12. Be able to recognize difficult

cases and refer them accordingly

13. Assist second and third year

residents in their surgeries

14. Be able to explain patients

condition and instruct patients

regarding their treatment and

follow up

15. Transport and store corneal

tissues properly

16. Clean, track and store corneal

punches and trephines properly

17. Fill up PKP protocol properly

18. Keep cornea protocol complete

and in order

19. Master streak retinoscopy using

phoropter and loose lenses

20. Be able to use the stenopeic slit

21. Master Jacksonian cross cylinder

technique

22. Master refining and balancing of

refraction

23. Do subjective refraction

24. Contact lens overrefraction


36

25. Able to measure papillary

distance for far and near

26. Prescribe proper reading adds

27. Suggest type of spectacle lenses

28. Fill up refraction prescription

completely and accurately

29. Proper use of keratometer

30. Removal of corneal foreign

bodies

31. ER management of corneal

injuries perforations, abrasions,

burns)

32. Removal of sutures


Knowledge

1. Pathogenesis pathophysiology, diagnosis,

differential diagnosis and treatment of the

following conditions

a. Corneal dystrophies and ectasias

b. Corneal degenerations

c. Corneal deposits

d. Corneal metabolism disorders

e. Congenital corneal anomalies and

opacities

f. Acquired corneal anomalies and

opacities

g. Infection related opacities

h. Trauma related opacities

i. Corneal decompensation

j. Recurrent erosion syndrome

k. Graft rejection

l. Persistent epithelial defects

m. Local corneal conditions

2. Diagnosis and management of toxic and

traumatic injuries of the cornea

3. Principles, indications, techniques,

complications, prognosis and follow-up

of corneal transplantation

4. Factors affecting corneal curvature and

quality of vision

5. Principles in repairing corneal injuries

6. Principles in visual rehabilitation of

corneal leukomas

7. Types of refractive surgery techniques

8. Principles, indications, technique and

complications of refractive surgery

9. Principles and methods of thorough

refractive screening

Skills

1. Formulate working diagnosis and

differential diagnosis of patients

with corneal diseases

2. Formulate management plans for

a cornea patient

3. Institute proper therapeutic

regimen for a cornea patient

4. Surgical management of simple

corneal problems

a. Repair of uncomplicated

corneal lacerations and

perforations

b. Surgical or laser pupilloplasty

c. Superficial keratectomy

d. EDTA scrub

e. Tarsorrhappy

f. Selective suture removal

g. Tissue glue application

5. Assist the consultant or the third

year resident in his surgeries


Knowledge Skills


1. Indications, techniques, complications,

pre-op preparation, post-op care of the

following corneal surgeries

a. Penetrating Keratoplasty (optical,

tectonic, therapeutic, cosmetic)

b. Patch graft

c. Rotating Keratoplasty

d. Lamellar Keratoplasty

e. Annular graft

f. PKP with LE and PCIOL

g. PKP with Vitrectomy and TSSPCIOL

h. Repair of corneal perforations

i. Repair of corneal perforation and iris

excision or repair

j. Repair of corneal perforations with

LE and PCIOL

k. Repair of corneal perforation with

Vitrectomy

l. Anterior segment reconstruction

m. Laser and surgical iridoplasty and

pupilloplasty

2. Principles of keratoprosthesis

3. Principles of limbal stem cell

transplantation

4. Principles, indications, techniques,

complication and follow-up of PRK and

PRK

5. Principles of LASIK and other

complicated refractive procedures

6. Management of refractive problems after

PKP

7. Recognition and management of corneal

graft rejection

1. Prepare comprehensive

management plans for the cornea

patient

2. Formulate rational surgical plan

and goals of surgery

3. Acquire all required operative

needs

4. Communicate with the consultant

properly

5. Establish rapport with the patient

and the family

6. Explain risk, benefits,

complication and options of

surgical procedure to the patient

adequately

7. Assist the consultant in his

surgeries

8. Able to perform adequately all

procedures listed in number 1 of

above

Suggested readings:

1. External Disease and Cornea, Section 8 Basic and Clinical Science Course 1998-99,

AAO

2. The Cornea, Smolin and Thoft, latest edition

3. Corneal Surgery, Brightbill, latest edition

4. Cornea, Vols. I to III Krachmer, Mannis Holland

5. Optics, Refraction and Contact Lenses, Section 3, Basic and Clinical Science Course,

AAO

6. Optics section of Duane’s Ophthalmology

Contact Lens Service



Knowledge

Anatomy and Physiology of the anterior

Skills

Measurement of ocular parameters


38

segment

Astigmatism

Corneal topography

Examination of the anterior segment

Optics of contact lens

Understand contact lens terminology

Contact lens solutions

Pupil size – bright and dark

Illumination

Palpebral aperture size

Corneal diameter

Vertex distance

Keratometer

Interpretation of keratometry results

Slit lamp biomicroscopy

Over-Refraction

Contact lens power modification

Contact Lens parameter design

Prescribe the correct CL solution for the

right contact lens material


Knowledge

Soft Contact Lens Design

Rigid Contact Lens Design

Specialty Lenses Design

Contact Lens Complication

Skills

Fitting of Soft Contact Lens

Fitting of Rigid Contact Lens

Identifying Complications/Remedy

Uveitis Service


Knowledge

1. Terminology used in Uveitis e.g. alopecia

areata, band keratopathy, busacca nodules,

Dalen Duchs nodules,

hypopyon, keratitis precipitates, koeppe

nodules, occlusio papillae, seclusion

papillae etc.

2. Anatomy and physiology of the uveal

tract including the pathophysiology of

inflammation involving the uveal tract

3. Basic ocular immunology, specifically

the different types of immune reaction

pertinent to the eye

4. Differentiate the various Uveitis

conditions according to the following:

a. Location

b. Pathologic type

c. Severity and course

d. Etiology

5. Essentials of history-taking in patient

with Uveitis

a. Common signs and symptoms

b. Geographic history

c. Family history

d. Demographic history

e. Personal/social history

f. Importance of medical history

6. Principles of examining a patient with

Skills

1. Extract a comprehensive history

from a uveitis patient

2. Perform a through eye

examination on an Uveitis patient

a. Identify areas involved in the

inflammatory process

b. Recognize the characteristic

signs of Uveitis

c. Score the degree of

inflammation

3. Present the patient’s history and

physical examination findings in a

systematic manner

4. Formulate a working diagnosis for

the Uveitis patient

5. Request for the appropriate

laboratory and diagnostic

examinations for patients with

Uveitis

6. Record patient’s data completely

a. History

b. Ophthalmologic findings

c. Laboratory examinations

d. Consultant’s

opinion/suggestions

7. Prescribe patient’s medication

properly


Uveitis

a. Basic eye examination

b. Use of various eye instruments

(indirect ophthalmoscope, slit lamp,

etc.)

7. Principles of medical management of

patients with Uveitis

8. Principles of surgical management of

patients with uveitis

8. Give periocular injections to

patients requiring them

9. Recognize patients requiring

surgical intervention and refer

them accordingly

10. Assist the second year and third

year residents in their surgeries on

Uveitis patients

11. Explain patient’s condition and

instruct patients regarding their

treatment


Knowledge

1. Various Uveitis entities and their

characteristic presentation

2. Complications of Uveitis

3. Principles of surgical management of

Uveitis patients

4. Appropriate course of action in the

management of complication seen in

Uveitis patients

Skills

1. Formulate a working diagnosis for

the Uveitis patient

2. Formulate a management plan for

the Uveitis patient

3. Institute a proper therapeutic regimen for the

Uveitis patient

a. Prescribe the drug of choice

b. Give the appropriate dosage

c. Choose the appropriate route

of administration

4. Surgical management of some

complications of Uveitis

a. Removal of band keratopathy

b. Laser iridotomy

c. Prophylactic peripheral

iridectomy

d. Periocular injections

5. Assist the third year resident in

performing surgical procedures on

the Uveitis patient


Knowledge

1. Principles in the performance of various

surgical procedures utilized in the Uveitis

patients

a. Goals of surgery

b. Indications for surgery

c. Choice of which surgical procedure

to perform in the Uveitis patient

d. Preoperative preparation of patients

for surgery

e. Surgical techniques

f. Post-operative management of

patients

1. Formulate the appropriate clinical

diagnosis

2. Perform the following procedures

in the Uveitis patients

a. Intracapsular cataract

extraction

b. ECCE/PKE with or without

IOL implantation

c. Lensectomy/anterior

Vitrectomy

d. Synechiolysis

e. Membranectomy

f. Inridectomies

g. Sphincterotomies

Suggested readings:

1. Section on Ocular Inflammation, AAO


40

2. Fundamentals of Uveitis and Immunology, Nussenblat, et al

3. Uveitis, Smith and Nozik

4. Chapters on Uveitis and Immunology, Duane’s Clinical Ophthalmology

Ophthalmic Oncology and Pathology Service


Knowledge

1. Normal gross anatomy, physiology and

histology of the eye and ocular adnexae

a. Cornea and sclera

b. Anterior chamber angle

c. Crystalline lens

d. Iris, ciliary body and choroid

e. Retina

f. Optic nerve

g. Lids

h. Conjunctiva

i. Extraocular muscles

j. Lacrimal glands

k. Other orbital contents

2. Basic light microscopy and familiarity

with common stains

a. HE

b. PAS

c. Mason’s trichrome

3. Proper preparation and handling of

specimen

Skills

1. Complete ocular examination

2. Funduscopy, direct and indirect

3. Basic slit lamp examination


Knowledge

1. Pathophysiology of common eye diseases

2. Diagnosis and differential diagnosis of

common ophthalmic tumors:

a. Retinoblastoma

i. Coats disease

ii. PHPV

iii. ROP

iv. Others

b. Uveal Melanoma

v. Nevus

vi. Melanocystoma

vii. Hemorrhagic AMD

viii. Others

c. Adult Orbital tumors

ix. Lymphoma

x. Pseudotumor

xi. Lacrimal gland tumors

xii. Hemangioma

xiii. Others

d. Pediatric orbital tumors

xiv. Rhabdomysarcoma

Skills

1. Master indirect ophthalmoscopy

with sclera indentation. Must be

able to locate, describe and

estimate, the size of intraocular

lesions

2. Surgical skills

a. Enucleation

b. Incision biopsies

c. Excision biopsies of small

lesions

d. AC tap for diagnosis

e. Fine needle aspiration Biopsy

(FNAB)


xv. Hematogenous tumors

xvi. Lymphangioma

xvii. Hemangioma

xviii. Dermoid cyst

xix. Others

e. Lid tumors

xx. Basal cell CA

xxi. Squamous cell CA

xxii. Sebaceous cell CA

xxiii. Melanoma

f. Tumors of the conjunctiva

xxiv. Actinic keratosis

xxv. CA in situ

xxvi. Squamous cell CA

xxvii. Melanosis

xxviii. Melanoma

3. Understanding of common imaging

procedures used in ophthalmology

a. UTZ

b. CT scan

c. MRI


Knowledge

1. Surgical and long-term management of

common ophthalmic tumors

2. Indications, contraindications and

complications of surgical management of

tumors

3. Indications, contraindications and

complications of adjunctive therapy:

a. Chemotherapy

b. Radiotherapy

4. Follow-up of cancer patients: Detection

of recurrence, new tumors, secondary

tumors, systematic spread

5. Laser photocoagulation of small tumors

Skills

1. Difficult Enucleation

2. Excision biopsies

3. Exenteration (assistive)

4. Cryotherapy

Glaucoma Service


Knowledge

1. Definition and concept of glaucoma

2. Classification of Glaucoma

a. Open-angle or angle-closure

b. Primary or secondary

c. Congenital glaucoma

3. Pathophysiology of Glaucoma

4. Basic anatomy of the eye particularly

a. Anterior chamber angle

b. Iris, ciliary body and choroid

c. Optic nerve and retina

Skills

1. Elicit a complete history

2. Perform basic ophthalmologic

examination

a. Slit-lamp examination of the

anterior segment

b. Slit-lamp examination of the

vitreous & retina

c. Slit-lamp examination of the

disc with the various lenses

d. Gonioscopy


42

5. Physiology and dynamics of aqueous

humor

6. Principles and technique of tonometry

7. Principles and techniques of fundus and

disc examination

8. Principles and Techniques of Perimetry

9. Principles and Philosophy of various

treatment modalities of glaucoma

10. Pharmacokinetics and

Pharmacodynamics of drug used in

glaucoma

11. Know the various instruments,

examinations used in the diagnosis and

treatment of glaucoma

12. Principles of various glaucoma surgical

procedures

13. Principles of various glaucoma laser

procedures

e. Tonometry (indentation &

applanation)

f. Funduscopy (direct, indirect,

slit lamp)

3. Assist the more senior resident in

their laser and surgical procedures


Knowledge

1. Must be able to give a working diagnosis

based on history and clinical findings

2. Must be able to give and defend

differential diagnoses

3. Must be knowledgeable on the different

syndromes/systemic conditions

associated with glaucoma

4. Must know the treatment options

5. Must be able to decide and which

treatment option is suitable for patient

6. Must know the side effects/complications

of various treatment modalities

7. Must be able to interpret visual field

results

Skills

1. Perform a complete glaucoma

evaluation

2. Do perimetric testing

a. Tangent screen

b. Goldmann perimetry

c. Automated perimetry

3. Competency assist the senior in the

performance of any glaucoma

surgery

4. Do cyclocryotreatment, laser

iridotomy, surgical iridotomy


Knowledge

1. Must be able to give and defend his/her

diagnosis

2. Must be able to rule out the differentials

3. Know the necessary tests/work-up

needed to establish to confirm diagnosis

4. Must be able to formulate and carry out

an appropriate treatment plan

5. Must be able to set treatment plan

6. Must be able to determine if treatment

goal is successful or not

7. Must be able to recognize and deal with

the complications resulting from

treatment

Skills

1. Laser and surgical iridotomy

2. Laser trabeculoplasty

3. Goniophotocoagulation

4. Laser iris retraction

5. Pupilloplasty

6. Trabeculectomy

7. Combine cataract operation and

drainage procedure

8. Choroidal tap

9. Pan-retinal photocoagulation

10. Yag-hyaloidectomy

11. AC tap

12. Vitreous tap

b. Aqueous humor formulation


c. Aqueous humor outflow

xxix. Trabecular outflow

xxx. Uveoscleral outflow

xxxi. Tonography

d. Episcleral venous pressure

e. Intraocular pressure

xxxii. As a risk factor in glaucoma

xxxiii. Factors influencing intraocular pressure

xxxiv. Diurnal variation

xxxv. Clinical evaluation of intraocular pressure

4. Clinical Evaluation of Glaucoma

a. History and examination

xxxvi. History

xxxvii. Refraction

xxxviii. External of the adnexae and anterior segment

xxxix. Pupillary examination

xl. Biomicroscopy

xli. Gonioscopy

xlii. Tonometry

xliii. Retinal examination be direct and indirect ophthalmoscopy

xliv. Perimetry

b. Gonioscopy

c. The optic nerve

xlv. Anatomy

xlvi. Theories of glaucomatous cupping

xlvii. Recording of the optic nerve changes

xlviii. Glaucomatous disc changes

d. The visual field

xlix. Technique and instruments used in kinetic and static perimetry

l. Interpretation of visual field changes

li. The glaucomatous field loss pattern

lii. Promising instruments and techniques forthcoming

5. Open-angle Glaucoma

a. Primary Open-Angle Glaucoma (POAG)

liii. Epidemiology

liv. Genetics

lv. Associated risk factors

lvi. Clinical features

b. The Glaucoma suspect

c. Normal (Low) tension glaucoma

d. Secondary open-angle glaucoma

lvii. Ocular inflammation

lviii. Steroid and drug related glaucoma

lix. Trauma

lx. Following surgery

lxi. Pseudoexfoliation

lxii. Pigmentary glaucoma

lxiii. Lens induced

lxiv. Intraocular tumor

lxv. Etc.


44

6. Angle-Closure Glaucoma

a. Mechanism and pathophysiology of glaucoma

b. Primary angle-closure glaucoma

lxvi. Associated with papillary block

lxvii. Not associated with papillary block

lxviii. Plateau iris

lxix. Malignant glaucoma

c. Secondary angle-closure glaucoma

lxx. Associated with pupillary block

lxxi. Not associated with papillary block

7. Combine-Mechanism Glaucoma

8. Congenital Glaucomas

a. Definition and classifications

b. Epidemiology and genetics

c. Clinical features

d. Pathophysiology

e. Differential diagnosis

f. Long term prognosis and follow-up

g. Developmental glaucomas associated with syndomes

9. Management of Glaucoma

a. Medical therapy of glaucoma

lxxii. Cholinergic agents

lxxiii. Adrenergic agents

lxxiv. Carbonic anhydrase inhibitors

lxxv. Beta-adrenergic antagonist

lxxvi. Alpha-2 agonist agents

lxxvii. Hyperosmotic agents

b. General approach to the medical management of glaucoma

c. Surgical management of glaucoma

lxxviii. Laser surgery

lxxix. Incisional surgery

lxxx. Techniques

lxxxi. Complications

lxxxii. Management of complication

10. Suggested Books

a. Lecture of Glaucoma by Chandler and Grant, IV Edition

b. Diagnosis and Therapy of the Glaucomas, Becker and Shaeffer

c. The Glaucomas, Robert Ritch

d. AAO Basic, Clinical Science Course Section in Glaucoma

Vitreo-Retinal Service


Knowledge

1. Retina: Embryology, Anatomy,

Physiology and Histology

a. The developmental of the optic cup

highlighting the development of the

different layers of the retina

b. Ten layers of the retina and functions

Skills

Retina

1. Direct Ophthalmoscopy

a. Must be proficient in the use

of direct ophthalmoscope and

all its accessories

b. Must understand the


of the individual cell layers and

specialized cells. Ex. The retinal

pigment epithelial cell: location (with

respect to the layers of the retina and

the choroid), its appearance (shape,

color, cellular content, special

features) its function in the outer

retina barrier

c. The morphology and topography of

the entire retina: Structures and

location of these structures, important

landmark and measurements

d. Vascular supply of the retina and the

optic nerve head

e. Neurologic connections and

projections of the retinal nerve fiber

layer to the occipital cortex

f. Relationship of the retina to the

vitreous: anatomic and physiologic

functions

g. Relationship of the retina of the

ciliary body: anatomy and histology

h. The blood retina barrier

i. The photochemical process (the

visual cycle)

j. The Physiology basis for color vision,

contrast sensitivity, dark adaptation

2. Vitreous: Embryology, Anatomy,

Histology and Physiology

a. The development of the optic cup

highlighting the development of the

retina and the primary, secondary and

tertiary vitreous

b. The structure of the vitreous body:

anatomy and histology

c. Functions of the vitreous body

d. Relationship of the vitreous to the

retina: functions and anatomic

connections, physiology

e. Degeneration of the vitreous (the

normal aging processes)

3. Choroid: Embryology, Anatomy,

Histology Physiology

a. The development of the optic vesicle

and cup highlighting the development of the

choroid, retina and vitreous

b. The anatomy of the choroid, its

vascular supply and anatomical and

physiological relationship to both

retina and sclera

limitations of the examination

in evaluating the retina and the

vitreous

2. Indirect Ophthalmoscopy

a. Must be able to understand the

principle behind the structure

of this ophthalmoscope and its

advantages and disadvantages

over the direct

ophthalmoscope

b. Must be proficient in the use

of the indirect

ophthalmoscope, including the

examination through a small

pupil, and be acquainted with

the use of all its accessories

and adjustments

c. Must be able to draw the

fundus using internationally

accepted color code and charts

3. Other tests: must be able to

perform and evaluate results of:

a. Amsler grid test

b. Macular photostress test


46

c. The special role of the

choriocapillaries in relation to the

retina (to include anatomy, histology

and physiology)

4. Retinal Electrophysiology

a. Must understand the anatomic and

physiology basis for ERG, EOG,

VER

b. Must be familiar with indications for

the examination


Knowledge ** In addition to what the first year

resident know

Pathologic responses

1. Macular edema

2. Retinal ischema

3. Pathogenesis of serous detachment of the

retina and RPE

4. Subretinal Neovascularization

Vascular disease of the retina

1. Diabetic retinopathy

a. Must know most recent staging of the

retinopathy and clinical presentation

of each stge

b. Must know the medical correlates of

retinopathy e.g. diabetes control, type

of diabetes, other complications, etc.

c. Must know the pathologic

correlates/pathophysiology of the

retinopathy in all stages

d. Must be aware of treatment

modalities and efficacy

e. Must be aware of the natural course

of the disease, and prognosis

2. Hypertensive Retinopathy

a. Must know the staging of the

retinopathy (Keith-Wagener-Barker, Scheie)

b. Must know the retinal changes that

are seen in all types of hypertension

c. Must know the complications that

may be seen in hypertensive

retinopathy (including toxemia of

pregnancy)

d. Must know the arteriorsclerotic

retinopathy stages

3. Venous Occlusive Diseease of the retina

(CRVO and BRVO)

a. Must know the clinical types of

CRVO and BRVO

b. Must know the significance of each

of the clinical types

Skills ** In addition to what the first year

residents can do

Indirect ophthalmoscopy: *In addition to

the first year residency “must know”

skills in IO

1. Must be able to locate retinal

breaks accurately and draw them

in the fundus chart/must be

proficient in sclera depression

2. Must know how to grade a PVR

or proliferative vitreoretinopathy

by Slit lamp biomicroscopy

3. Must know how to evaluate

retinal details with a slit lamp and

fundus lens

4. Must know how to evaluate the

status of the vitreous and its

relationship to the retina using a

slit lamp and a fundus lens

5. Must know how Optical Coherence

Tomography and Fluorescein Angiography are

done, the indications and normal

test results.

6. Must know how to clinically (bedside and

outpatient) diagnosis of vitreoretinal diseases

7. Must be able to suggest management

(diagnostic/therapeutic) of cases seen

8. Must be able to perform basic vitreoretinal

surgical assisting (second assist)


c. Must know the pathophysiology of

the disease, systemic correlates, the

probable causes and complications

d. Must be aware of treatment options

and prognosis

4. Retinal Arterial Occlusion (CRAO and

BRAO)

a. Must know the possible etiology and

systemic correlates

b. Must know the pathophysiology,

clinical presentation, and natural

course of the disease

c. Must know possible complications


and prognosis

5. Retinal Microinfarcts of various causes

(e.g. collagen disease, fat embolism,

Putcher’s Disease, etc.)

a. Must know the possible systemic

correlates

b. Must know the pathophysiology of

each disease state, clinical

presentation and its natural course

c. Must know complications of each

condition


and prognosis

6. Retinopathy of prematurity

a. Must know the staging of the disease

b. Must know pathophysiology and risk

factors

c. Must know prognosis

7. Others: must know pathophysiology, risk

factors, medical correlates, prognosis

a. Rheumatic disease

b. Hematologic disorders

c. Eales’ disease

d. Ocular Ischemic syndromes

e. Retinal Telangiectasias & Coats

Disease

f. Virus retinitis, retinal necrosis

syndrome (including aids retinitis)

g. Pigmentary degeneration of the retina

a. Patho-physiology

b. Genetics

c. Fundus manifestations and FA

findings

d. Associated syndromes

e. Macular involvement

Disorders of the Macula


48

1. Age Related Macular Degeneration

a. Must know the pathophysiology of

pre-AMD lesions like drusen and of

the different types and stages of

AMD

b. Must know types of AMD, stages of

the “wet” type AMD, clinical

presentation, and the natural course of

each type

c. Must know complications of the

disease, rate of recurrence,

bilaterality, aggravating factors

d. Must know treatment options and

prognosis

2. Central serous choroidoretinopathy

a. Must know pathophysiology and

types of the disease

b. Must know the clinical presentation

and natural course

c. Must know rate of recurrence,

bilaterality, aggraving factors

d. Must know treatment options and

prognosis

3. Cystoid Macular Edema or CME

a. Must know pathophysiology of the

disease

b. Must know the clinical presentation

and the natural course

c. Must know the possible etiology,

aggraving or risk factors

d. Must be aware of treatment options,

prognosis, complications

4. Macular Holes

a. Must know most recent staging of the

disease (both impending macular hole

and macular holes)

b. Must know pathophysiology

c. Must know possible etiology,

aggraving factors

d. Must know the natural course of the

disease

e. Must be aware of treatment options

f. Must know prognosis and

complications

5. Macular Pucker (Pre-retinal Fibrosis,

Cellophane retinopathy)

a. Must know staging of the disease

b. Must know pathophysiology of the

disease

c. Must know possible etiology,

aggraving factors


d. Must know the natural course of the

disease

e. Must be aware of treatment options

f. Must know prognosis and

complications

Inflammatory Disease

Must know pathophysiology, etiology, clinical

presentation, natural course, prognosis,

complications, treatment options

1. Pars planitis

2. Ocular Toxocariasis

3. Ocular Toxoplasmosis

4. Ocular cysticercosis

5. Cytomegalovirus infection of the retina

6. Acute retinal necrosis syndrome

7. VKH syndrome

8. Serpigenous Choroiditis

9. Acute posterior multifocal placoid

pigment epitheliopathy (APMPPE)

10. Sympathetic Ophthalmia

11. Syphilis and Tuberculosis

12. AIDS

13. Endophthalmitis

14. Birdshot

15. Ciliochoroidal Effusion

Other Diseases: must know causes

pathophysiology, clinical presentation, natural

course, complication, prognosis treatment

options

1. Toxic retinopathies

2. Radiation retinopathies

3. Photic injuries to the macula

4. Traumatic injuries to the posterior

segment

5. Vitreous hemorrhage

Peripheral retinal degeneration: must know

Pathophysiology, natural course, presentation,

complication, treatment options

1. Lattice degeneration

2. Choroiretinal atrophis scars

3. Meridional folds

4. Microcystic degeneration of the

peripheral retina

5. Peripheral retinoschisis

Retinal Detachment

1. Must know differentiation between

rhegmatogenous and non-rhegmatogenus

types

2. Must know types of retinal breaks and

how they are produced and the


50

predisposing and risk factors

3. Must know PVR or proliferative

vitreoretinopathy and grading,

pathophysiology and grading

4. Must know causes of nonrhegmatogenous

retinal detachments and

work-up needed for the determination of

etiology of these cases

Retinoschisis: must know the different types,

pathology, difference from retinal detachment,

histology, natural course prognosis

Tumors of the retina, choroid, vitreous: must

know etiology and primary source, natural

course, clinical presentation

1. Retinoblastoma

2. Leukemias and lymphoid tumor

3. Reticulum cell sarcoma

4. Metastatic disease: know common

primary sources, male and female

5. Choroidal melanomas

Vitreous Abnormalities: must know causes,

Pathology, natural course, prognosis

1. Asteroid hyalosis

2. Synchisis sscientillans

3. Symptomatic posterior vitreous

detachment

4. Vitreous hemorrhage

5. Vitreous amyloidosis

Intraocular Trauma: must know how to

recognize the condition, evaluate the patient,

prognosticate, and formulate a plan of

management

1. Intraocular foreign body

2. Vitreous Hemorrhage from blunt

Trauma, Valsalva’s maneuver,

perforating injuries

3. Double perforating injuries

4. Choroidal rupture

5. Retinal edema from blunt trauma

(Berlin’s edema and RPE edema)

6. Sclopetaria Retinitis

7. The battered child syndrome and retinal

detachment

8. Combination of some of the above

Myopia: know the different presentations of

myopic degeneration of the retina, pathology,

prognosis, treatment options

Hereditary diseases/Congenital problems:

know

modes of transmission, clinical presentation,

pathology, prognosis


1. Retinitis Pigmentosa

2. Stargardt’s Disease

3. Color Blindness

4. Best’s Vitelliform Macular Degeneration

5. Juvenille Foveal Retinochisis

6. Marfan’s syndrome (retinal problems)

7. Retino-choroidal colobomas

8. Retinal angiomatosis

9. Persistent Hyperplastic primary vitreous

(PHPV)

Fundus Flourescein Angiography

1. Must know how the procedure is done

2. Must know the indications for the

procedure

3. Must know contra-indications ,

precautions, complications

4. Must know the “normal” test results

5. Must know basis FA interpretation

Ocular Ultrasonography



procedure

3. Must know the salient features of a

normal study

4. Must be able to recognize simple

abnormalities in the test results

Electrophysiology


2. Must know the anatomic and physiology

basis for the tests: ERG, EOG, VER


procedure


5. Must be able to recognize simple

deviations form the normal test results

Optical Coherence Tomography



procedure


4. Must know how to interpret a standard

printout of examination results

Other Tests

1. Entoptic imagery

2. Ophthalmodynamometry

Laser treatment skills

The second year resident must know the

principles and physics of lasers in general,

including laser safety, must know the basic

laser


52

technique of panretinal photocoagulation, for

retinal ischemic disease such as diabetic

retinopathy and veno-occlusive disorders, the

complications as well as indication, patient

orientation and preparation and post laser care.

He must also be aware of basic laser technique

and indications for the treatment of peripheral

retinal lesions such as lattice degeneration,

silent

retinal breaks


Knowledge ** In addition to everything that

the

first and second year residents know

1. Management: The third year resident

must know the definitive management for

each of the disease states mentioned in

the second year program, including their

side effects, interactions with other

medical treatments. He/She must know

the complications of non-treatment, the

prognosis of treatment and nontreatment,

the natural course of the

disease

2. Surgical Management. The Third year

resident must know the indications for

surgery, the reasons for the choice of the

surgical technique, the prognosis after

surgical technique, the possible

complications of surgery, the prognosis

after surgical management, post operative

care and follow-up

a. Scleral buckling: Implants, explants, radial,

circumferential, combinations,

with SRF, without SRF drainage

b. Vitrectomy: simple and complicated

with other complicated, with other

procedures like retinotomies, internal

drainage air/fluid exchange,

membrane peeling,

endophotocoagulation, silicone oil

fill, long acting gas fill (SF6 and

perflourocarbons)

c. Cryotherapy: for retinoblastoma for

telangiectasias and vascular

abnormalities, for peripheral retinal

lesions, for pneumatic retinopexy, for

retinal ablation in ROP and diabetic

retinopathy and other retinal ischemic

conditions, for sclera buckling, sclera

lacerations

Skills ** In addition to what the 1st and

2nd year residents must be able to do

1. Surgery

a. The third year resident must

be able to assist the retinal

surgeon in all types of sclera

buckling operations, all types

of vitrectomies, pneumatic

retinopexy

b. Must follow-up the patient

after the surgery and know his

post-operative course, Identity

his postoperative problems

and be able to formulate a

plan for their management.

Corollary to this he must

understand the reason for the

post-operative problems and

management

2. Instrumentation: With the

indirect ophthalmoscope and slit lamp

biomicroscopy with the

fundus lens

a. Must be able to precisely

localize retinal breaks and

other lesions and draw them

on the fundus chart

b. Must be able to predict with

reasonable accuracy the

location of a retinal break

based on the extent and

topography of the retinal

detachment

c. Must be able to grade PVR

with accuracy

d. Must be able to use the

technique of vitreous

evaluation with slit lamp and

fundus lens fairly accurately

and determine the extent of


d. Pneumatic retinopexy: must be aware

for patient selection

3. Laser treatment: The third year resident

must know the various techniques for

retinal photocoagulation, must know the

indications for treatment, their

complications and post treatment care.

He must be knowledgeable on laser

physics and safety

vitreous pathology and

participation in vitreo-retinal

problems

e Must be able to interpret abnormal optical

coherence tomograph (macula)

f. Initiate management (diagnostic/therapeutic)

of cases seen

g. Must be able to prognosticate disease, pre-

operative and post-operative patient counseling

h. Must be able to perform Panretinal and focal

(for peripheral retinal degenerations) laser

photocoagulation

i. Must be able to perform advanced

vitreoretinal surgical assisting (First assist)

j. Must be able to do preparation and assisting

for intravitreal injection/drug administration

Reference:

1. Principle and Practice of Ophthalmology by Albert and Jacobiec Retina vol. 1-3 by S.

Ryan

2. Ophthalmology by Duane

3. AAO Basic and Clinical Science Course Section on Retina

Pediatric Ophthalmology and Motility Service


Knowledge

1. Anatomy

a. Extraocular muscle – origin,

insertion, innervations, blood supply,

histology, actions

b. Spiral of Tillaux

c. Intraorbital structures – relationships

with EOMs

d. Scleral thickness in different areas

2. Physiology

a. Actions of muscles

b. Axes of Fick, Listing’s plane

c. Sherington’s Law

d. Herring’s Law

e. Binocular vision

3. Examinations

a. Amblyoscope, titmus fly

4. Specific ocular conditions

a. Congenital/infantile esotropia and

accommodative esotropia

b. Intermittent and constant exotropia

c. Paralytic squint

d. Amblyopia

5. Medical management

a. Patching

b. Optical treatment

Skills

Ductions, Versions

Sensory Tests

1. Visual acuity in children

2. Cycloplegic refraction

3. Ductions, versions

4. Cover, uncover, alternate cover

test

5. Hirshberg, Krimsky, prism cover

test

6. Red glass test

7. Forced duction test

8. Red Green diplopia test

9. 3-Step test for vertical muscle

palsy

Cycloplegic refraction, spectacle

prescription


54

6. Surgical management

Principles of timing and choice of

surgery


Knowledge

1. Ocular conditions

a. A and V patterns in horizontal

strabismus

b. Thyroid ophthalmology

c. Duane’s syndrome

d. Brown’s syndrome

e. DVD

f. Double elevator palsy

g. Myasthenia gravis

h. Cyclovertical palsy


a. Recess resect

b. Adjustable muscle surgery

Skills

Assist in surgery


Knowledge


a. Steps

2. Intra and post operative complications

Skills

1. Performance of surgery

(horizontal muscle only)

2. Management of complications

Ocular Conditions in Pediatric Ophthalmology

1. Pediatric cataract

2. Retinoblastoma

3. Ophthalmia neonatorum

4. Pre-septal and orbital cellulitis

5. Congeniotal nasolacrimal duct obstruction

6. Red eye in children

7. Congenital Ptosis

8. Down’s syndrome

9. Congenital Ptosis

10. Congenital glaucoma

11. Anterior segment dysgenesis

12. Colobomas

13. Congenital nystagmus

14. Capillary hemangioma

15. Microphthalmos, nanophthalmos

16. ROP

17. Different varieties of PHPV; Retinal Dysplasia

Reference:

1. AAO Basic and Clinical Science Course Section on Motility and Pediatric

Ophthalmology

Neuro-Ophthalmology and Visual Electrophysiology Service


Knowledge Skills


1. Anatomy

a. Visual sensory system pathway

- Retina

- Optic disc

- Optic nerve

- Optic chiasm

- Optic tract

- Lateral geniculate body

- Optic radiation

- Occipital cortex

b. Other cranial nerve pathways

- III

- IV

- V

- VI

- VII

- VIII

c. Pupillary pathways

- Parasysympathetic

- Sympathetic

- Intranuclear

d. Gaze pathways

- Supranuclear

- Internuclear

- Infranuclear

- Nuclear

e. Basic Principles of Electrophysiology

testing (ERG, EOG, VER)

f. Basic Principles of CT Scan and MRI

of the orbit and cranium

1. Visual function tests

a. Visual acuity

b. Funduscopy

c. Color vision

d. Amsler grid

e. Brightness comparison

f. Photostress recovery

2. Visual field tests

a. Confrontation

b. Perimetry

3. Ocular motility tests

a. Red glass

b. Hirschberg’s

c. Cover-uncover

d. Prism

4. Neurologic examination

a. Cranial nerves

b. Motor

c. Sensory

d. Autonomic

e. Cerebellar

f. reflexes

5. Pupil examination

a. Test for anisocoria

b. Light reaction

c. Consensual

d. Near-reflex

e. Pharmacologic tests

6. Test for saccade

7. Test for pursuit

8. Test for vergence (convergence)


Knowledge

1. Knowledge and skills of first year

2. Pathophysiology and recognition of the

following:

a. Optic nerve disorders

- Congenital abnormalities

- Optic disc edema, papilledema, optic

neuritis, ischema optic neuropathies,

pseudopapilledema

- Optic atrophy

- Trauma

- Tumors

b. Ocular motor system disorders

- Syndromes of III, IV and VI

nerve paralysis

- Vertical and horizontal eye

- Movement abnormalities

- nystagmus

Skills

Same as first year


56

c. Facial nerve disorders

- Bell’s palsy

- Hemifacial spasm

d. Trigeminal neuralgia

e. Pupillary disorders, Marcus Gunn,

Adie’s pupil, Argyll Robertson’s

pupil, pharmacologic accidents,

Homer’s syndrome

f. Systemic disorders

- Multiple sclerosis

- Neurocutaneous sysdromes:

neurofibromatosis, tuberous

sclerosis

- Cerebrofacial angiomatosis,

Ataxia telangiectasia

- Chronic progressive external

ophthalmoplegia

- Myasthenia gravis

g. Visual pathway and visual field

lesions in neuro-ophthalmology

3. Indications for visual electrophysiology

testing

4. Procedure for ERG, EOG, VER and other

visual electrophysiologic tests


Knowledge

1. Knowledge and skills of second year

2. Complications and management/and/or

referral of the eye disorders mentioned in

second year

3. Muscle surgeries for paralytic squints

- Recession , resection

- Hummelscheim operation

- Jensen’s procedure

Skills

1. Evaluation of patient with

neuroophthalmologic

findings

associated with

- EOM disorders

- Brain tumors

Other neurologic

affectations

2. Basic interpretation of normal and

abnormal visual

electrophysiologic results

3. Basic interpretation of orbital and

cranial CT scan and MRI results

Reference:

AAO Basic and Clinical Science Course Section on Neuro-Ophthalmology

Cataract Service


Knowledge

1. Embryology and development of the lens

2. Anatomy and histology of the lens

3. Physiology and biochemistry of the lens

4. Optical properties of the lens

5. Congenital anomalities of the lens

Skills

1. History taking and physical

examination of cataracts and other

lens anomalities

2. Slit lamp classification and

grading of cataracts


6. Acquired anomalities of the lens

7. Lens anomalies secondary to systemic

disease

8. Definition of cataracts

9. Classification of cataracts by anatomic

location and by etiology

10. Grading of cataracts based on slit lamp

features

11. Types of cataracts (senile, pre-senile,

congenital, juvenile or developmental,

secondary to ocular diseases, secondary

to systemic diseases, secondary to

metabolic diseases, secondary to heredity

disorders, secondary to trauma,

secondary to drugs/noxious, secondary to

radiation)

12. Pathogenesis of different types of

cataracts

13. Etiologies and theories of cataract

formation

14. Risks factors of cataract developmement

15. Visual impact of cataracts

16. Refractive changes essential to cataracts

17. Refractive changes induced by cataracts

18. Diagnosis of cataracts

19. Indications for cataract surgery

20. Contraindications of cataract surgery

21. Natural course of cataracts

22. Complications of cataracts

23. Principles and techniques of ocular

anesthesia

3. Refracting a cataract patients

4. Visual acuity determination of

cataract patients

5. Visual prognostication of cataract

patients

6. Filling up the cataract protocol

7. Assisting cataract surgery

8. Postop examination and follow up

of cataract surgery

9. Refraction after cataract surgery

10. Retrobulbar, peribulbar and lid

anesthesia

11. Recognition and management of

anesthesia complications

12. Biometry, Keratometry and

computation of IOL power


Knowledge

1. Principles of different types of cataract

surgery

a. Intracapsular cataract extraction

b. Extracapsular cataract extraction

(large incision)

c. Small incision cataract extraction

d. Phacoemulsification cataract

extraction

e. Femtosecond Laser-Assisted Cataract

Surgery

2. Principles and options of post cataract

visual rehabilitation

3. Principles of intraocular lenses and lens

power measurement

4. Principles of ultrasonic biometry

5. Preoperative preparation of cataract

patients

Skills

1. Assisting all types of lens and

cataract surgery

2. Do ultrasonic biometry

3. Do Nd: YAG capsulotomy

4. Practice basic steps of

Extracapsular cataract surgery

a. Dilation, anesthesia, asepsis

b. Wound construction

c. Capsulotomy

d. Lens expression and delivery

e. Irrigation and aspiration of

cortical material

f. Intraocular lens implantation

g. Wound closure and suturing

techniques recognition of

intraoperative and

postoperative complications


58

6. Principles, indications, techniques and

complications of Nd: YAG capsulotomy

7. Risk, benefits and complications of each

type of cataract surgery

8. Surgery induced cystoids macular edema

9. Principles of secondary lens implantation

a. ACIOL

b. Ciliary Sulcus PCIOL

c. Transclerally sutured PCIOL (TSSPCIOL)

10. Cataract surgery instrumentation

11. Operative needs of cataract surgery


Knowledge

1. Principles in choosing the appropriate

lens power, type and model

2. Principles in choosing the appropriate

viscoelastic and solution

3. Indications, contraindications, techniques

and complications of each type of

cataract surgery

a. Intracapsular cataract surgery

b. Large incision Extracapsular cataract

surgery

c. Phacoemulsification

d. ACIOL implantation

e. TSS-PCIOL implantation

4. Principles of surgically induced

astigmatism

5. Prevention and management of

intraoperative and postoperative

complications

a. Tight lids

b. Retrobulbar hemorrhage

c. High preop IOL

d. High posterior vitreous pressure

e. Inadequate anesthesia

f. Poor visibility

g. Bleeding and hyphema

h. Superior rectus complication (globe

rupture, muscle transaction, paresis)

i. Poor wound construction

j. Premature entry into AC

k. AC shallowing

l. Floppy iris and dialysis

m. Incomplete capsulotomy and capsular

tags

n. Inadequate nuclear mobility

o. Radial tears

p. Difficult nuclear delivery

q. Posterior capsule rupture

r. Vitreous loss

Skills

1. Mastery in doing Extracapsular

cataract surgery

2. Knowledge and basic proficiency

in performing intracapsular

cataract surgery

3. Mastery in the implantation of

PCIOL (capsular and sulcus, rigid

and foldable)

4. Proficiency in putting ACIOL and

TSS-PCIOL

5. Mastery in the management of

posterior capsule rupture and vitreous loss

6. Capacity to judge adequacy of

capsule remnant for PCIOL

placement

7. Choosing the appropriate IOL

power based in biometer readings

8. Mastery of Phacoemulsification

techniques

9. Mastery of the techniques of

wound construction, capsulotomy,

capsulorrhexis, hydrodissection

and hydrodelineation, nuclear

rotation and manipulation,

automated and manual cortical

removal, lens placement and

wound closure

10. Mastery in the proper handling

and positioning of micro-surgical

instruments

11. Mastery in the use of the

operating microscope

12. Ability to make quick and sound

judgment when faced with

difficult

13. Ability to recognize and manage

common complications related to

cataract surgery and refer all cases


s. Retained lens material

t. Non-dilating pupils

u. IOL degeneration, subluxation and

disclocation

v. Descemet membrane tear

w. Wound leak

x. Iris prolapsed

y. IOL-iris capture

z. Vitreous wick

aa. Post op glaucoma

bb. Post op iritis

cc. Post op corneal edema

dd. Post op infection including

endophthalmitis

ee. Astigmatism, ametropia and

anisometropia

ff. Retinal detachment

gg. Cystoid macular edema

hh. Macular photoxidity

6. Principles of the Phacoemulsification

7. Phacodynamics

8. Principles and instrumentation of small

incision cataract surgery

9. Management of complicated cataracts

a. Pseudoexofoliation cataracts

b. Hypermature cataracts

c. Morgagnian cataracts

d. Instumescent cataracts

e. Lens induced Uveitis and glaucoma

f. Phacodonesis

g. Lens subluxation (post trauma,

Marfan’s)

h. Diabetic with cataracts

i. Post traumatic cataracts

j. Partially absorbed cataracts

k. Pediatric cataracts

requiring further management

14. Be able to establish rapport with

the patient prior to surgery and

able to address all issues raised by

the patient including options,

complications and prognosis

15. Be able to prepare adequately all

instruments and operative needs

required prior to the surgery

16. Be able to follow up the patient

properly and provide the best

visual recovery including

astigmatism management

Do proper Nd: YAG capsulotomy and

deal with complications of the procedure

Suggested readings:

1. Sections on Lens and cataract, optics, refraction and contact lenses and fundamentals

2. Section on cataract in Duane’s or in Albert and Jakobiex

3. Adler’s physiology of the eye

4. Ophthalmic surgery by G. Spaeth

5. Cataract surgery by Jaffe et al


60

D. UERMMMCI House Staff Policies Rules and Regulation 2013-2014

1. Resident/Fellow Eligibility and Selection

Residents and fellows in accredited programs at UERMMH are selected based on

qualifications that meet or exceed the standards outlined below.

To be eligible for appoint to a residency or fellowship program at UERMMH, the

applicant must satisfy the following requirements:

Graduate of government-recognized medical school in the Philippines or

foreign country with medical degree (Doctor of Medicine) as primary

program.

Licensed to practice medicine in the Philippines (must show proof) or show

exemption from such by Professional Regulatory Commission.

Must be of good moral character.

Licensed to practice medicine in the Philippines (must show proof) or show

exemption from such by the Professional Regulatory Commission.

Must not have been convicted or under investigation for a crime in a court

law (show Police or NBI Clearance)

Must show proof of good behavior from the institution he/she graduated.

Must present at least two recommendation letters from two faculty with

whom the applicant had undergone tutelage.

Must pass battery of test that may be required by the hospital (physical

examination, laboratory screening tests, psychosocial test, x-rays, etc.)

Must profess to abide by the rules and regulations of the hospital.

2. Offenses and Incident Reports

MINOR OFFENSES:

1. Commission of acts causing or tending to cause the Medical Center to lose man hours

such as engaging in horseplay and other physical acts irrespective of whether or not it

may endanger patients, and their relatives and visitors, employees and other persons.

2. Loitering, sleeping, lying down, or idling during working hours.

3. Selling or distributing merchandise or any other article within the Medical Center

premises without proper authorization

4. Unsanitary act such as spitting, blowing nose, urinating in a manner or in places other

than those designated for such purpose or littering in the Medical Center premises,

contributing to poor sanitation or poor housekeeping.

5. Erasing, smearing, charging, or tampering with any poster, notices or announcements

posted by the Medical Center.

6. Unauthorized use of telephone.

7. Stating false reason/s for being absent.

8. Any boisterous behaviour or disorderly conduct that may distract others in the

performance of their duties.

9. Reporting for work while afflicted with a contagious disease without first submitting a

medical clearance or failure to report his affliction of a contagious disease to his

superior or to the infirmary.

10. Male interns entering female interns’ quarters and vice versa.

11. Failure to make timely report of the occurrence of loss of Medical Center property, or


damage to machine, equipment or other Medical Center property.

INTERMEDIATE OFFENSES:

1. Damage to property belongings to the Medical Center, its employees, patients or

visitors due to negligence.

2. Loss of specimen(s) of patients assigned or entrusted to him arising out of negligence.

Example: pathological tissue after a procedure, spinal fluids and such other specimen

requiring special procedure to obtain.

3. Loss of patient charts or official records of the hospital arising out of negligence.

4. Loss of records or documents in which the Medical Center has an interest arising out

of negligence.

5. Causing injury to person within Medical Center premises arising out of negligence.

6. Unauthorized possession or removal of Medical Center properties or personal

properties of its employees, patients, or visitors.

7. Dishonestly

8. Vandalism

9. Unauthorized withdrawal of Medical Center records or documents.

10. Disclosure or giving of confidential information, articles or Medical Center secrets to

unauthorized persons.

11. Fighting or threatening, provoking or instigating a fight.

12. Soliciting directly any sum of money, unauthorized commission, offer, promise in

consideration of any act, contract, decision, or service connected with the discharge of

the house staff member’s official duties.

13. Usurious practice

14. Unauthorized use of Medical Center properties, facilities and equipment.

15. Threatening another person directly or indirectly, with the infliction of any injury

upon person, family, honor, or property.

16. Refusal or failure to comply with security requirements of Medical Center.

17. Willful and unauthorized opening of another’s locker, drawer, or office even though it

does not result in actual loss.

MAJOR OFFENSES:

1. Willful disregard of authority and gross disobedience to any school official, member

of the faculty, administration or their representatives.

2. Robbery, theft, estafa, swindling, or malversation committed against the Medical

Center, its employees, patient or visitors.

3. Falsification of Medical Center records, forms or any document in which the Medical

Center has an interest.

4. Forgery

5. Giving false testimony or introduction of spurious of falsified evidence in any Medical

Center investigation.

3. Disciplinary Sanctions

Minor Offense:

18. First Offense: Written Reprimand

19. Second Offense: One (1) Month Suspension

20. Third Offense: Three (3) Months Suspension

21. Fourth Offense: Exclusion or Termination


62

Intermediate Offense:

1. First Offense: Three (3) Months Suspension

2. Second Offense: Exclusion or Termination

Major Offense:

3. First Offense: Exclusion or Termination

Note:

6. The court of offense/s is regardless if the violation is the same or of a different

nature within the level of sanction.

7. The disciplinary sanction is cumulative. This means that the level of the last

disciplinary sanction incurred will be the basis of the next disciplinary sanction

if another violation is occurred.

This does not preclude the Disciplinary Committee from conducting an investigation and give

due process to the House Staff involved.

4. Leave Policy

UERMMH recognizes that a resident may need to be away from work due to medical or certain

family reasons. Leaves of absence are defined as approved time away from residency duties,

other than regularly scheduled days off as reflected in a rotation schedule. All leaves will be

scheduled with prior approval by the Chief of Clinics, with the exception of emergencies or

unexpected illnesses.

In unexpected/emergency situations, the resident should contact the Chief of Clinics or

Department Head at the earliest possible time.

The amount of time a resident can be away from residency duties and still meet Board

requirements varies among the specialties It is the resident’s responsibility to be aware of his/her

specialty requirement.

If leave time is taken beyond what is allowed for the specialty board and the resident is required

to extend his/her period of activity in the training program, the resident should request permission

to extend and should establish a schedule for doing so in consultation with the Chief of Clinics.

Leave time under any of these categories will not be counted toward Board eligibility.

When the need/request for leave is foreseeable, the request should be submitted at least thirty (30)

days prior to the leave. When the need for the leave is unforeseeable, the request should be

submitted as soon as practical.

BEREAVEMENT LEAVE If there is a death in your family, you may take up to 3 working days off as leave with pay. For

this purpose, “family” is defined as spouse, child, mother, father, mother-in-law, father-in-law,

sister, brother, or grandparent.

HOLIDAY/VACATION/SICK TIME

The amount of time a resident can be away from residency duties and still meet Board

requirements vary among the specialties. It is the resident’s responsibility to be aware of his/her

specialty requirement. Time under any of the following may not be counted toward Board

eligibility.


1. Holiday

All time off, including holidays, is scheduled at the direction of the Chief of

Clinics.

Official UERMMH holidays are not automatically observed as time off for house

staff.

2. Vacation

Vacation is scheduled and approved by the Chief of Clinics. A resident may take

two weeks of scheduled paid vacation.

Any unused time does not carry over and is not convertible to cash at the

appointment yearend.

3. Sick time

5. Grievance Procedures

HOUSE STAFF COMPLAINT/GRIEVANCE PROCEDURES

Situations may arise in which a resident believes he/she has not received fair treatment by a

member of the faculty or staff of the Medical Center, or a representative of the Medical Center, or

has a complaint about the performance, action or inaction of a member of the staff or faculty.

Retaliation against a resident for submitting to a dispute investigation through the

complaint/grievance procedures will not be tolerated and will result in appropriate disciplinary

actions.

PROCEDURE-OTHER COMPLAINTS

The investigation should be directed as soon as possible to the person(s) whose actions or

inactions have given rise to the complaint and not later than fourteen days (14) after the event. If

the person(s) involved is not the department chair or program director and/or department chair to

seek their assistance in the resolution of the issue. Every effort should be made to resolve the

problem fairly and promptly at this level.

Complaints not resolved at this level within 30 days should be referred to the attention of the

Medical Director within two weeks following the failure to resolve the issue at the department

level. The Medical Director will seek to resolve the issue and may at his/her discretion seek

advice from other members of the faculty, house staff, or staff as deemed appropriate.

After such evaluation and/or consultation, the Medical Director or Chief of Clinics will make a

decision. If the resident disagrees with the decision, he/she must, within 14 days after the receipt

of the COC’s decision, notify in writing, the Executive, who will then direct the issue to the

Board of Discipline through the Office of the President, to address the appeal.

The Board of Discipline will meet within 14 days after the receipt of the written appeal. Any

member of the Board of Discipline (faculty or house staff) who has a potential conflict of interest,

as determined by the Chair of Board of Discipline will not be permitted to vote. Likewise, if there

is a potential conflict of interest between the chair and the appealing resident, the Board of

Discipline will elect a temporary chair of the Board of Discipline for the purpose of the review.


64

Either party can have legal counsel present during the Board of Discipline deliberations. The

Board of Discipline will make a recommendation to the President of the Medical Center, who will

then make the final decision.

RETALIATION

“Retaliation” includes any adverse employment action or act of revenge against an individual for

filing or encouraging one to file a complaint of discrimination, participating in an investigation of

discrimination, or opposing discrimination.

Residents who file a grievance/complaint, report activity which they believe to be unlawful, or

participate in the grievance, review, or compliance process in good faith, will be protected against

retaliation.

Residents who believe that they have been subjected to retaliation as a result of any of these

actions should contact the Office of the Medical Director, which will investigate complaints of

retaliation.

6. Policy on Inclement Weather and Other Emergencies

The Center ensures the safety and welfare of its staff especially in the emergency situations such

as floods, heavy rains, storm and typhoon, transportation problems, and calamities that endanger

the house staff’s health, safety and well-being.

The Center may, at its option, allow its staff to leave the office earlier that the regular dismissal

time, is the situation warrants, due to the imminent danger posed to the well-being of it

employees.

PROCEDURES:

In cases wherein house staff members are in the hospital and are threatened by such

calamities described above, early dismissal should first be cleared with the Hospital

Administrator or Medical Director.

In cases wherein it is deemed safer for house staff members to stay in the premises of the

Center, they may be allowed to stay in the premises.

Specific places where the house staff may stay during this time shall be designated by the

Hospital Administration.


E. List of Required Surgeries (PBO 2009)

Minimum

Number

Supervised (w/ GRASIS form)

Lid Surgery 4

Tarsorrhapy 1

Repair of Lid Laceration 3

Excision of Lid Mass (Non-Margin) 2

Corneal Foreign Body Removal 5

AC Parecentesis 1

Pterygium Excision 20 10

Corneo-Scleral Repair 4 2

Muscle Surgery (Horizontal MM) 2 2

Cataract Surgeries 40

Phacoemulsification w/ IOL 12

ECCE w/ IOL 12

Cataract Surgery in Glaucoma 1

Cataract Surgery in Uveitis

Cataract Surgery in

1

Cataract Surgery in Pediatric 1

Trabeculectomy 5 4

Peripheral Iridectomy/Iridotomy 5 2

Cyclocryotheraphy 1

Yag capsulotomy 4 3

Enucleation/Evisceration 2 1 of each

Anterior Segment Vitrectomy 1 2

Pan-retinal photocoagulation 5 2

Incision & curretage of chalazion 20 5


66

MUST ASSIST SURGERIES DACRYOCYSTORHINOSTOMY ENTROPION / ECTROPION SURGERY

PTOSIS SURGERY EXCISION OF LID MASS (MARGIN) EXENTERATION 1 COMBINED FILTERING AND CATARACT SURGERY

PENETRATING KERATOPLASTY

SCLERAL BUCKLING

Must Know Surgeries

(NO NEED FOR ANY NAMES OF PATIENTS. EVALUATION WILL BE CONDUCTED

THROUGH THE WRITTEN AND ORAL PBO EXAMS)

BLEPHAROPLASTY LASER TRABECULOPLASTY MUSCLE SURGERY (VERTICAL MM) POSTERIOR SEGMENT VITRECTOMY EXCIMER LASER SURGERY (PRK, LASIK, ETC.)

ORBITOTOMY PROCEDURES REPAIR OF ANOPHTHALMIC SOCKETS

PART I. VISION AND MISSION University of the East Ramon ... 2016 Body.pdf · Memorial Medical...

Documents

Transcript of PART I. VISION AND MISSION University of the East Ramon ... 2016 Body.pdf · Memorial Medical...